Last #TenTweetNephJC thread of 2022
Intradialytic hypotension (IDH) is deeply unpleasant but very common. We hope cooling dialysate to cause vasoconstriction prevents IDH, helping prevent myocardial stunning.
So does cooling dialysate improve cardiovascular outcomes?
Intradialytic hypotension (IDH) is deeply unpleasant but very common. We hope cooling dialysate to cause vasoconstriction prevents IDH, helping prevent myocardial stunning.
So does cooling dialysate improve cardiovascular outcomes?
What did I miss?
The #NephJC discussion on the largest ever trial in patients on haemodialysis called MyTEMP, examining the policy many units deploy of cooling dialysate for all patients.
pubmed.ncbi.nlm.nih.gov
The #NephJC discussion on the largest ever trial in patients on haemodialysis called MyTEMP, examining the policy many units deploy of cooling dialysate for all patients.
pubmed.ncbi.nlm.nih.gov
1 tweet methods
✅ Adult patients on HD >90 days in Ontario
✅ Pragmatic, registry-based, cluster-randomized superiority trial
✅ Each centre randomised to either dialysate at 36 degrees, or cooled to 0.5 degrees below patient temperature
✅ Adult patients on HD >90 days in Ontario
✅ Pragmatic, registry-based, cluster-randomized superiority trial
✅ Each centre randomised to either dialysate at 36 degrees, or cooled to 0.5 degrees below patient temperature
1 tweet results
🔹84 units = 15413 patients, mean follow-up 1.8 yrs
🔹Composite CV outcome = 21.4% with cooled dialysate 🆚 22.4% standard temp = HR 1.00 (CI 0.89 to 1.11, p=0.93)
🔹 No difference in IDH
🔹More patients reported feeling “uncomfortably cold” in cooled arm
🔹84 units = 15413 patients, mean follow-up 1.8 yrs
🔹Composite CV outcome = 21.4% with cooled dialysate 🆚 22.4% standard temp = HR 1.00 (CI 0.89 to 1.11, p=0.93)
🔹 No difference in IDH
🔹More patients reported feeling “uncomfortably cold” in cooled arm
A figure paints 1000 words
Give me something clever to say
“Meta-analysis in NDT this year indicated that cooled dialysate helps with restless leg syndrome based on a few small trials, but see MyTEMP supplementary fig.5 - no difference in RLS in this large randomised study”
pubmed.ncbi.nlm.nih.gov
“Meta-analysis in NDT this year indicated that cooled dialysate helps with restless leg syndrome based on a few small trials, but see MyTEMP supplementary fig.5 - no difference in RLS in this large randomised study”
pubmed.ncbi.nlm.nih.gov
Chat consensus?
1️⃣ Fantastic trial to investigate an important clinical question
2️⃣ No clinical reason to cool your whole unit any more
3️⃣ Things are different if your patient already has IDH - probably still worth a trial of cooling to see if it helps on individual basis
1️⃣ Fantastic trial to investigate an important clinical question
2️⃣ No clinical reason to cool your whole unit any more
3️⃣ Things are different if your patient already has IDH - probably still worth a trial of cooling to see if it helps on individual basis
Quote of the fortnight!
I want more info
✅ Follow @AALJaishi & @AmitXGarg
✅ Read a statistically superior tweetorial from study author
✅ NephJC summary from @dana_m_larsen
nephjc.com
✅ VA by @thana_susan👇
✅ Follow @AALJaishi & @AmitXGarg
✅ Read a statistically superior tweetorial from study author
✅ NephJC summary from @dana_m_larsen
nephjc.com
✅ VA by @thana_susan👇
Final thoughts
✳️ Looking forwards to further big cluster-randomised trials soon - RESOLVE (dialysate Na), DialMAG (dialysate Mg), & more
➡️ Next will be the long-awaited NefIgArd study - oral budesonide for IgA nephropathy. See you in 2023!
Tweetorial by @jamiekwillows
✳️ Looking forwards to further big cluster-randomised trials soon - RESOLVE (dialysate Na), DialMAG (dialysate Mg), & more
➡️ Next will be the long-awaited NefIgArd study - oral budesonide for IgA nephropathy. See you in 2023!
Tweetorial by @jamiekwillows
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