Conventionally, dialysis centres have provided hemodialysis using a standard dialysis fluid temperature of 36.5°C for all patients. Based on preliminary evidence that using a cooler dialysis fluid may have cardiovascular benefits, a growing number of centres are using a cooler temperature of 36°C or lower in patient care.
The MyTEMP trial was conducted to examine whether providing dialysis using a cooler dialysis fluid reduced the risk of cardiovascular-related hospital admission or death compared with using a standard temperature of 36.5°C. The MyTEMP trial team was led by Dr. Amit Garg, a nephrologist at the London Health Sciences Centre and Professor of Medicine, Epidemiology and Biostatistics at Western University. Dr. Garg also leads a Can-SOLVE CKD research project focused on increasing the use of living donor kidney transplantation.
The trial was conducted from 2017 to 2021 in 84 of Ontario’s 97 hemodialysis centres. Centres were randomized to one of two groups. In one group, the temperature of the dialysis fluid was set to be 0.5°C below each patient’s body temperature as measured prior to starting dialysis (referred to as personalized cooler dialysate). In the other group, the temperature was set to 36.5°C for all patients and all treatments (referred to as standard temperature dialysate).
The researchers used several innovative methods to conduct this trial, including:
- Integrating the intervention into routine care with minimal to no healthcare disruption for patients or staff.
- Including all patients at the 84 centres in the trial.
- Making use of routinely collected data from existing administrative health data sources to reliably assess outcomes.
MyTEMP is the largest trial of maintenance hemodialysis published to date, including over 95% of patients receiving hemodialysis in Ontario during the trial period, totalling more than 15,000 patients who had more than 4.3 million dialysis treatments.
The trial resulted in three publications, which can be found here:
At the end of the trial, the MyTEMP team examined how many patients had cardiovascular-related hospitalizations or deaths in each group. They found that adopting a centre-wide policy of personalised cooler dialysate versus a standard dialysate temperature did not reduce the risk of major adverse cardiovascular events or death. In addition, patients in the personalised cooler dialysate group were more likely to report feeling cold on dialysis than respondents in the standard-temperature group.
The team concluded that the intervention lacked measurable benefit, which was compounded by the likelihood of patient discomfort, indicating that cooler dialysate should not be adopted as a centre-wide policy.
“Based on the trial’s findings, dialysis centres that are currently providing cooler dialysate as a centre-wide policy should consider using a dialysate temperature of 36.5°C as their standard for the comfort of their patients,” said Dr. Garg. “The role of cooler dialysate in the management of specific types of patients who have frequent episodes of low blood pressure during dialysis now needs to be clarified in future studies.”