Influence of dialysate temperature on creatinine peritoneal clearance in peritoneal dialysis patients: a randomized trial

Francesco Fontana, Chiara Torelli, Silvia Giovanella, Giulia Ligabue, Gaetano Alfano, Karin Gerritsen, Rafael Selgas, Gianni Cappelli, Francesco Fontana, Chiara Torelli, Silvia Giovanella, Giulia Ligabue, Gaetano Alfano, Karin Gerritsen, Rafael Selgas, Gianni Cappelli

Abstract

Background: Patients on continuous ambulatory peritoneal dialysis (PD) are encouraged to warm dialysate to 37 °C before peritoneal infusion; main international PD guidelines do not provide specific recommendation, and patients generally warm dialysate batches partially or do not warm them at all. Warming of dialysate is a time-consuming procedure, not free from potential risks (i.e. degradation of glucose), and should be justified by a clear clinical benefit.

Methods: We designed a single blind randomized controlled trial where 18 stable PD patients were randomized to receive a peritoneal equilibration test either with dialysate at a controlled temperature of 37 °C (intervention group) or with dialysate warmed with conventional methods (control group). Primary end-point was a higher peritoneal creatinine clearance in patients in the intervention group.

Results: Patients in the intervention group did not show a significantly higher peritoneal creatinine clearance when compared to the control group (6.38 ± 0.52 ml/min vs 5.65 ± 0.37 ml/min, p = 0.2682). Similar results were obtained for urea peritoneal clearance, mass transfer area coefficient of creatinine and urea. There were no significant differences in total abdominal discomfort questionnaire score, blood pressure and body temperature between the two groups.

Conclusions: Using peritoneal dialysate at different temperatures without causing significant side effects to patients appears feasible. We report a lack of benefit of warming peritoneal dialysate to 37 °C on peritoneal clearances; future PD guidelines should not reinforce this recommendation.

Trial registration: NCT04302649, ClinicalTrials.gov ; date of registration 10/3/2020 (retrospectively registered).

Keywords: Dialysate temperature; Peritoneal clearance; Peritoneal dialysis.

Conflict of interest statement

We have read and understood BMC Nephrology policy on conflicts of interest disclosure and declare that we have none.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Peritoneal creatinine clearance in the uncontrolled dialysate temperature group (light grey bar) and 37° dialysate temperature group (dark grey bar)
Fig. 3
Fig. 3
Peritoneal urea clearance in the uncontrolled dialysate temperature group (light grey bar) and 37° dialysate temperature group (dark grey bar)
Fig. 4
Fig. 4
Dialysate to plasma ratio for creatinine and urea (left and middle panel, left y axis) and dialysate drained volume (right panel, right y axis) for the uncontrolled dialysate temperature group (light grey bar) and 37° dialysate temperature group (dark grey bar)
Fig. 5
Fig. 5
Peritoneal mass transfer urea coefficients (MTAC) for creatinine (left panel) and urea (right panel) in the uncontrolled dialysate temperature group (light grey bars) and 37° dialysate temperature group (dark grey bars)

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