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Randomised trial comparing standard versus thermocontrolled haemodialysis using intradialytic cardiac, brain and renal magnetic resonance imaging

Gullapudi, Venkata R. Latha; Cox, Eleanor F.; Buchanan, Charlotte E.; Canaud, Bernard; White, Kelly; Taal, Maarten W.; Selby, Nicholas M.; Francis, Susan T.

Randomised trial comparing standard versus thermocontrolled haemodialysis using intradialytic cardiac, brain and renal magnetic resonance imaging Thumbnail


Authors

Venkata R. Latha Gullapudi

Bernard Canaud

Kelly White



Abstract

Background
Ischaemic end-organ damage during haemodialysis (HD) is a significant problem that may be ameliorated by intradialytic cooling. A randomised trial was performed to compare standard HD (SHD; dialysate temperature 37°C) and programmed cooling of the dialysate [thermocontrolled HD (TCHD)] using multiparametric magnetic resonance imaging (MRI) to assess structural, functional and blood flow changes in the heart, brain and kidneys.

Methods
Prevalent HD patients were randomly allocated to receive either SHD or TCHD for 2 weeks before undergoing serial MRI at four time points: pre-, during (30 min and 180 min) and post-dialysis. MRI measures include cardiac index, myocardial strain, longitudinal relaxation time (T1), myocardial perfusion, internal carotid and basilar artery flow, grey matter perfusion and total kidney volume. Participants then crossed to the other modality to repeat the study protocol.

Results
Eleven participants completed the study. Separation in blood temperature between TCHD (−0.1 ± 0.3°C) and SHD (+0.3 ± 0.2°C; P = .022) was observed, although there was no difference in tympanic temperature changes between arms. There were significant intradialytic reductions in cardiac index, cardiac contractility (left ventricular strain), left carotid and basilar artery blood flow velocities, total kidney volume, longitudinal relaxation time (T1) of the renal cortex and transverse relaxation rate (T2*) of the renal cortex and medulla, but no differences between arms. Pre-dialysis T1 of the myocardium and left ventricular wall mass index were lower after 2 weeks of TCHD compared with SHD [1266 ms (interquartile range 1250–1291) versus 1311 ± 58 ms, P = .02; 66 ± 22 g/m2 versus 72 ± 23 g/m2, P = .004].

Conclusions
HD adversely affects cardiac function, reduces carotid and basilar artery blood flow and total kidney volume, but mild dialysate cooling using a biofeedback module did not result in differences in intradialytic MRI measures compared with SHD.

Citation

Gullapudi, V. R. L., Cox, E. F., Buchanan, C. E., Canaud, B., White, K., Taal, M. W., Selby, N. M., & Francis, S. T. (2024). Randomised trial comparing standard versus thermocontrolled haemodialysis using intradialytic cardiac, brain and renal magnetic resonance imaging. Nephrology Dialysis Transplantation, 39(2), 233–241. https://doi.org/10.1093/ndt/gfad150

Journal Article Type Article
Acceptance Date Jun 30, 2023
Online Publication Date Jul 11, 2023
Publication Date 2024-02
Deposit Date Jul 22, 2023
Publicly Available Date Jul 26, 2023
Journal Nephrology Dialysis Transplantation
Print ISSN 0931-0509
Electronic ISSN 1460-2385
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 39
Issue 2
Pages 233–241
DOI https://doi.org/10.1093/ndt/gfad150
Keywords Diagnostic imaging, dialysis, haemodynamics, myocardium, temperature
Public URL https://nottingham-repository.worktribe.com/output/23005422
Publisher URL https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfad150/7222913?login=false

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