Portable sauna stimulated-diaphoresis for the treatment of fluid-overload in peritoneal dialysis patients: A pilot study

Pablo Maggiani-Aguilera, Jonathan S Chávez-Iñiguez, Guillermo Navarro-Blackaller, Karla Hernández-Morales, Ariadna Lizbeth Geraldo-Ozuna, Luz Alcantar-Villín, Olivia Montoya-Montoya, Víctor Hugo Luquín-Arellano, Guillermo García-García, Pablo Maggiani-Aguilera, Jonathan S Chávez-Iñiguez, Guillermo Navarro-Blackaller, Karla Hernández-Morales, Ariadna Lizbeth Geraldo-Ozuna, Luz Alcantar-Villín, Olivia Montoya-Montoya, Víctor Hugo Luquín-Arellano, Guillermo García-García

Abstract

Background: Fluid overload (FO) is a common problem in patients with peritoneal dialysis (PD), it is associated with adverse outcomes and may persist despite adjustements in PD therapy.

Objective: To evaluate the feasibility and safety of stimulated diaphoresis to reduce FO with the use of a portable sauna bath.

Methods: Open-label pilot study in patients on continuous ambulatory peritoneal dialysis (CAPD) and FO. The primary outcome was the treatment-related adverse events; secondary outcomes were changes in over-hydration (OH), body weight and blood pressure, FO symptoms, and sleep quality. Dialysis prescription and daily data were recorded. The intervention period consisted in a 30-min, 45°C sauna bath, daily for 10 days, using a portable sauna bath.

Results: Fifty-one out of 54 total sauna bath sessions were well tolerated. In three (5.5%) sessions adverse effects were reported: transient dizziness in two cases, and a second-degree skin burn in a patient with advanced diabetic neuropathy. OH (6.3 ± 1.2 L vs. 5.5 ± 1.3 L, p = 0.05), body weight (67.7 ± 11.4 vs. 66.8 ± 3.8 kg, p = 0.003), diastolic blood pressure (92 ± 13.5 vs. 83 ± 13.3 mmHg, P = 0.003) and PSQI score (7.3 ± 3.7 vs. 5.1 ± 3.2, p = 0.02) improved significantly between the control and intervention period, respectively.

Conclusions: Stimulated diaphoresis with a portable sauna bath could be a novel, safe, and effective alternative way to reduce FO in CAPD patients. Larger studies are needed to confirm our results.

Clinical trial registration: ClinicalTrials.gov, identifier: NCT03563898.

Keywords: chronic kidney disease; diaphoresis; fluid overload; peritoneal dialysis; sauna bath.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Maggiani-Aguilera, Chávez-Iñiguez, Navarro-Blackaller, Hernández-Morales, Geraldo-Ozuna, Alcantar-Villín, Montoya-Montoya, Luquín-Arellano and García-García.

Figures

Figure 1
Figure 1
Portable sauna bath.
Figure 2
Figure 2
Cohort selection. CAPD, continuous ambulatory peritoneal dialysis.

References

    1. Blake PG, Bargman JM, Brimble KS, Davison SN, Hirsch D, McCormick BB, et al. . Clinical practice guidelines and recommendations on peritoneal dialysis adequacy 2011. Perit Dial Int. (2011) 31:218–39. 10.3747/pdi.2011.00026
    1. Wabel P, Moissl U, Chamney P, Jirka T, Machek P, Ponce P, et al. . Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant. (2008) 23:2965–71. 10.1093/ndt/gfn228
    1. Chazot C, Wabel P, Chamney P, Moissl U, Wieskotten S, Wizemann V. Importance of normohydration for the long term survival of haemodialysis patients. Nephrol Dial Transplant. (2012) 27:2404–10. 10.1093/ndt/gfr678
    1. Agarwal R. Hypervolemia is associated with increased mortality among hemodialysis patients. Hypertension. (2010) 56:512–7. 10.1161/HYPERTENSIONAHA.110.154815
    1. Paniagua R, Ventura M, Avila-Díaz M, Hinojosa-Heredia H, Méndez-Durán A, Cueto-Manzano A, et al. . NTproBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients. Nephrol Dial Transplant. (2010) 25:551–7. 10.1093/ndt/gfp395
    1. Tzamaloukas AH, Saddler M, Murata GH, Malhotra D, Sena P, Simon D, et al. . Symptomatic fluid retention in patients on continuous peritoneal dialysis. J Am Soc Nephrol. (1995) 6:198–206. 10.1681/ASN.V62198
    1. Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, Rode C, et al. . The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant. (2009) 24:1574–9. 10.1093/ndt/gfn707
    1. Demirci MS1 DC. Relations between malnutrition-infl ammationatherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients. Nephrol Dial Transplant. (2011) 26:1708–16. 10.1093/ndt/gfq588
    1. Foley RN, Herzog CA, Collins AJ. United States renal data system. Blood pressure and long-term mortality in United States hemodialysis patients: USRDS waves 3 and 4 study. Kidney Int. (2002) 62:1784–90. 10.1046/j.1523-1755.2002.00636.x
    1. Kalantar-Zadeh K, Regidor D, Kovesdy CP, Van Wyck D, Bunnapradist S, Horwich TB, et al. . Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation. (2009) 119:671–9. 10.1161/CIRCULATIONAHA.108.807362
    1. Kimmel PL, Varela MP, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, et al. . Interdialytic weight gain and survival in hemodialysis patients: effects of duration of ESRD and diabetes mellitus. Kidney Int. (2000) 57:1141–51. 10.1046/j.1523-1755.2000.00941.x
    1. Saran R, Bragg-Gresham J, Rayner HC, Goodkin DA, Keen ML, Van Dijk PC, et al. . Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int. (2003) 64:254–62. 10.1046/j.1523-1755.2003.00064.x
    1. Charra B. Fluid balance, dry weight, and blood pressure in dialysis. Hemodial Int. (2007) 11:21–31. 10.1111/j.1542-4758.2007.00148.x
    1. Kim Y, Biesen WV. Fluid overload in peritoneal dialysis patients. Semin Nephrol. (2017) 37:43–53. 10.1016/j.semnephrol.2016.10.006
    1. Lacher JW, Schrier RW. Sweating treatment for chronic renal failure. Nephron. (1978) 21:255–9. 10.1159/000181401
    1. Man in 't Veld AJ, van Maanen JH, Schicht IM. Stimulated sweating in chronic renal failure. Br Med J. (1978) 2:172–3. 10.1136/bmj.2.6131.172-a
    1. Snyder D, Merrill JP. Sauna baths in the treatment of chronic renal failure. Trans Am Soc Artif Intern Organs. (1966) 12:188–92.
    1. Shibasaki M, Crandall CG. Mechanisms and controllers of eccrine sweating in humans. Front Biosci. (2010) 2:685–96. 10.2741/s94
    1. Cui CY, Schlessinger D. Eccrine sweat gland development and sweat secretion. Exp Dermatol. (2015) 24:644–50. 10.1111/exd.12773
    1. Pruijm M, El-Housseini Y, Mahfoudh H, Jarraya F, Hachicha J, Teta D, et al. . Stimulated sweating as a therapy to reduce interdialytic weight gain and improve potassium balance in chronic hemodialysis patients: a pilot study. Hemodial Int. (2013) 17:240–8. 10.1111/j.1542-4758.2012.00751.x
    1. Keller RW Jr, Kopple JD, Kalantar-Zadeh K. Perspiration interventions for conservative management of kidney disease and uremia. Curr Opin Nephrol Hypertens. (2020) 29:57–63. 10.1097/MNH.0000000000000569

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi