The following is a summary of “Physical intradialytic patient-reported outcome measures in hemodialysis and haemodiafiltration: A cross-over study,” published in the May 2023 issue of Nephrology by Wijngaarden, et al.

For a study, researchers sought to compare physical intradialytic patient-reported outcome measures (PID-PROMs) and thermal perception among different dialysis modalities, including standard hemodialysis (sHD), cool dialysis (cHD), low-volume haemodiafiltration (lvHDF), and high volume haemodiafiltration (hvHDF).

In a cross-over randomized trial, 40 patients were assigned to each dialysis modality for 2 weeks. The dialysate temperature (Td) was set at 36.5°C for sHD, lvHDF, and hvHDF, while cHD (Td 35.5°C) was performed at a dialysate temperature of 35.5°C. Target convection volumes were set at 15 L for lvHDF and ≥23 L for hvHDF. PID-PROMs were assessed using a modified Dialysis Symptom Index (mDSI), and thermal perception was evaluated using the Visual Analogue Scale Thermal Perception (VAS-TP). 

In addition, body temperature (T_b) and room temperature were measured. The study found no significant differences in PID-PROMs between the different dialysis modalities. However, there was considerable variation in PID-PROMs among patients for 11 out of 13 items assessed. T_b increased during sHD, lvHDF, and hvHDF (mean increase of 0.30°C, 0.35°C, and 0.38°C, respectively, all P < .0005), while it remained stable during cHD (mean increase of 0.04°C, P = .43). Thermal perception did not change significantly in sHD and both HDF modalities, but there was a shift towards feeling cold during cHD (P = .007).

The study concluded that PID-PROMs were largely patient-dependent and did not differ significantly between the dialysis modalities. However, there was significant variation in PID-PROMs among individual patients. For example, T_b increased during sHD, lvHDF, and hvHDF, while thermal perception remained stable. In contrast, cHD led to a perception of feeling cold. Therefore, cHD should be avoided in individuals who are perceptive to cold sensations.

Source: onlinelibrary.wiley.com/doi/10.1111/nep.14154