Profound Hypothermia as a Rare Presentation of Uremic Syndrome in a Patient With Advanced Chronic Kidney Disease: A Case Report and Literature Review.

Hypothermia is a rare but serious manifestation of uremic syndrome, which is rarely reported in the literature in patients with advanced chronic kidney disease (CKD). Hypothermia, defined as a core body temperature below 35°C, is categorized into mild (32-35°C), moderate (28-32°C), and severe (<28°C) stages, each associated with increasing risk of mortality. The human body relies on enzymatic processes and thermoregulatory mechanisms to maintain homeostasis, which can be disrupted in uremia due to toxin accumulation from impaired renal function. We present a case of a patient with CKD stage V who was planned for dialysis initiation but developed clinical signs of uremia before, in the form of uremic hypothermia with a core temperature of 34°C. Other potential causes, such as sepsis, trauma, exposure, and endocrine abnormalities, were ruled out. Pathophysiology may involve the accumulation of endogenous cryogens leading to peripheral vasodilation and suppressed shivering, thus impairing thermoregulation. Remarkably, the patient's symptoms and temperature improved following the initiation of dialysis, supporting a possible association between uremia and hypothermia. This case highlights profound hypothermia as a rare and potentially life-threatening presentation of uremic syndrome. Prompt recognition and initiation of renal replacement therapy are crucial for recovery.