الفهرس 
Hemodialysis AdequacyOnly 14 pages are availabe for public view
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Abstract
Manipulation of dialysate temperature is an easy maneuver
which can change the blood temperature, warm dialysate can increase
the body core temperature, resulting in vasodilation and increased
mobilization of sequestered toxins to intravascular compartment. The
contrary physiological change i.e. vasoconstriction can similarly be
induced by cool dialysate (Selby and McIntyre, 2006).
The aim of this work was to Study the effect of cold dialysate
on dialysis adequacy measured by urea reduction ratio (URR), KT/V
and B2 microglobulin serum level and in the mean time post dialysis
fatigue in regular hemodialysis patients using dialysis recovery time
as a surrogate marker of post dialysis fatigue.
To achieve this target, we performed a prospective cross over
study included 70 ESRD patients on regular haemodialysis at
Menoufia University Hospitals, spanning from October 2022 till
October 2023. The study approved by the local Ethical Committee of
the Menoufia University to conduct this study and to use facilities in
hospitals with Deceleration of Helsinki. Informed written consents
obtained from all participants after getting an explanation regarding
the purpose of this study before the study initiation.
All the studied patients underwent (6) dialysis sessions aday
after day: three on cold Dialysate then another three dialysis session
day after day on warm Dialysate: (a) cool dialysis with dialysate at
35.5°C, and (b) warm dialysis with dialysate at 37°C. The interval
between two study is one month. Pre dialysis blood samples were
collected at the start of cold and warm dialysis sessions and post
dialysis blood sample were collected at the end of cold and warm Dialysate sessions to quantify the dialysis adequacy and toxin
reduction ratio on maximum tolerated blood flow, Dialysate flow 500
ml / min, duration of Hemodialysis session 4 hours, three sessions per
week on fersenius machine using high flux dialyzer, The study
included patients aged more than 18 years and regularly undergo
thrice-weekly hemodialysis for 4 hours per session for more than 3
months.
Patients with acute coronary syndrome, arrythmia, chronic heart
failure and extreme changes in blood pressure are excluded from this
study (Mustafa et al., 2016).
All the included patients were subjected to Socio-demographic
data, Co-morbidities and clinical examination with emphasize on
mean arterial pressure (MAP) and body mass index (BMI). The basic
laboratory data at the beginning of the study included complete blood
picture (CBC). Corrected serum calcium, phosphorus, intact PTH,
serum albumin and Liver function test (SGOT, SGPT), Dialysis
adequacy parameters (URR, Kt/v, serum B2microglobulin),
assessment of postdialysis fatigue conducted TIRD calculated briefly
by patient‘s answers to the following single open-ended question:
‗How long does it take you to recover from a dialysis session?‗
Responses subsequently converted into the number of minutes.
(Lindsay et al., 2006) and assessment of fatigue by Piper fatigue scale
(Ostlund et al., 2007).