Investigation of coronary artery calcification and stenosis by coronary angiography CAG in haemodialysis patients
consistently shown the benefits of cool dialysis in the prevention of IDH. Certainly, prescription of isothermic treatments controlled by the blood temperature feedback module (BTM) is not only appealing from a theoretical point of view, but was also found to be efficacious for the prevention of IDH in the randomized crossover trial by Maggiore et al. [8] However, a practical drawback for the use of BTM controlled dialysis is that this feature is only available on dialysis modules of a single manufacturer, whereas dialysate temperature can be easily adjusted on every dialysis module. Also, a feeling of coldness is not entirely prevented by isothermic dialysis sessions (5% of sessions) [8] which might be theoretically explained by an increase in the temperature setpoint during dialysis. In our dialysis centre, we have the practice of gradually reducing dialysate temperature from 36.5 C to a minimum of 35.5 C, depending on the haemodynamic response and subjective feelings of comfort in our patients. By this approach, together with strict volume control, aided by the use of vena cava echography, and adjustment of dialysis time if necessary, the incidence of IDH in our centre is well below 5% Treatments are well tolerated by the patients without shivering. Thus, we believe that in patients prone for IDH, a gradual lowering of dialysate temperature, which should be individualized according to the haemodynamic response and side effects in the patient, would appear a rational alternative when BTM controlled modules are not available.