Effects of Low Dialysate Temperature on Intradialytic Hypotension and Dialysis Adequacy in Chronic Hemodialysis: A Systematic Review and Meta-Analysis.

BACKGROUND

Intradialytic hypotension (IDH) is a common and clinically significant complication in patients undergoing chronic hemodialysis. The application of low-temperature dialysate has been proposed as a potential intervention to mitigate this condition; however, its effectiveness requires further evaluation through systematic reviews and meta-analyses.

METHODS

A comprehensive literature search of articles published up to April 10, 2025, systematically searched electronic databases (PubMed, Embase, CINAHL, and Cochrane Library). Quality assessment was performed using the Cochrane Risk of Bias 2 tool for randomized crossover trials.

RESULT: Low dialysate temperature significantly decreases the incidence of IDH (OR = 0.35, 95% CI: [0.28, 0.46], p < 0.001), increases mean arterial pressure (SMD = 0.67, 95% CI: [0.38, 0.96], p < 0.001), and mean systolic blood pressure (SMD = 0.54, 95% CI: [0.30, 0.79], p < 0.001). Additionally, low dialysate temperature improves urea clearance dialysis adequacy (SMD = 0.25, 95% CI: [0.03, 0.47], p = 0.029) and urea reduction rate (SMD = 0.24, 95% CI: [0.02, 0.47], p = 0.035), while decreasing intradialytic mean body temperature (SMD = -0.68, 95% CI: [-0.99, -0.37], p < 0.001). The subgroup analysis revealed that dialysate temperatures between 34.5°C and 35.0°C were more effective in improving these related outcomes compared to temperatures ranging from 35.1°C to 36.0°C.

CONCLUSIONS

Maintaining low dialysate temperatures between 34.5°C and 36.0°C is recommended to reduce the incidence of IDH and improve dialysis adequacy in chronic hemodialysis patients. The specific low dialysate temperature should be individualized to minimize IDH risk, enhance patient comfort, and optimize treatment outcomes.