What does using room temperature dialysate (peritoneal dialysis fluid) in peritoneal dialysis (PD) mean?

Room Temperature Dialysate in Peritoneal Dialysis

Room temperature dialysate in peritoneal dialysis refers to using dialysis fluid at ambient room temperature (typically 20-25°C) rather than warming it to body temperature (37°C) before infusion into the peritoneal cavity. 1

Key Aspects of Room Temperature Dialysate

• The Sleep-Safe APD (Automated Peritoneal Dialysis) machine operates with dialysate at ambient room temperature, eliminating the need for a warming component that is present in some other APD systems 1
• This contrasts with systems like the Baxter APD machine, which includes a component to heat dialysate to near body temperature before infusion 1
• Room temperature dialysate (20-25°C) is significantly cooler than body temperature (37°C) 1

Clinical Benefits of Room Temperature Dialysate

• Using room temperature dialysate may provide hemodynamic benefits for patients rather than being detrimental 1
• Low-temperature dialysate has been shown to decrease the frequency and intensity of symptomatic hypotension compared to standard temperature dialysate 1
• Cooler dialysate improves the reactivity of blood vessels and is associated with improved cardiac contractility 1
• In hemodialysis, reducing dialysate temperature from 37°C to 34-35°C increases peripheral vasoconstriction and cardiac output, thereby reducing the occurrence of hypotension 2

Evidence Supporting Room Temperature Dialysate

• A randomized controlled trial found no significant difference in peritoneal creatinine clearance between patients using dialysate at 37°C versus dialysate at room temperature 3
• The same study reported no significant differences in total abdominal discomfort, blood pressure, or body temperature between the two temperature groups 3
• The researchers concluded there was a "lack of benefit of warming peritoneal dialysate to 37°C on peritoneal clearances" 3

Practical Implications

• Using room temperature dialysate eliminates:
  • The need for additional energy consumption for heating 1
  • Potential risks associated with overheated dialysate 1
  • The complexity and maintenance requirements of heating components 1

Management Considerations

• For patients who report discomfort with room temperature dialysate:
  • Allow dialysate bags to reach room temperature before use if they've been stored in cold environments 1
  • Consider adjusting ambient room temperature where the APD machine is used 1
• Monitor for signs of intolerance such as discomfort or shivering 1

Common Pitfalls to Avoid

• Don't assume that warmed dialysate is always better for patients - research suggests cooler dialysate may actually provide hemodynamic benefits 1
• Avoid storing dialysate bags in overly cold environments before use, as extremely cold dialysate could cause patient discomfort 1

Conclusion

Room temperature dialysate represents a practical approach to peritoneal dialysis that eliminates the need for warming components while potentially offering hemodynamic benefits. Recent evidence suggests that warming dialysate to body temperature provides no significant advantage in terms of clearance or patient comfort 3.