Intradialytic hypotension (IDH) is a common complication during hemodialysis, particularly in patients with septic shock who are critically ill and require vasopressor support. IDH can lead to inadequate dialysis, fluid overload, ischemic injury, and increased mortality. In septic shock patients, the combination of vasodilation, impaired cardiac output, and aggressive ultrafiltration makes blood pressure management challenging during dialysis. While dialysate cooling has been shown to reduce IDH
Conditions
Interventions
Patients in this group will receive acute hemodialysis with dialysate temperature set at 35.5 Celsius. The intervention aims to reduce the incidence of intradialytic hypotension by inducing mild perip
Dialysate cooling at 35.5 Celsius,Dialysate cooling at 36.0 Celsius,Standard care (dialysate at 37.0 Celsius)
Sponsors
Buriram Hospital
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Inclusion criteria
Inclusion criteria: 1.Age 18 years or older 2.Diagnosed with septic shock according to Sepsis-3 criteria 3.Requires vasopressor to maintain mean arterial pressure of 65 mmHg or higher 4.Has serum lactate level greater than 2 mmol/L after adequate fluid resuscitation 5.Planned to undergo acute hemodialysis within 24 hours 6.Able to undergo dialysis in the dialysis unit or acute care area without requiring mechanical ventilation or advanced life support 7.Informed consent obtained from patient or legal representative
Exclusion criteria
Exclusion criteria: 1.History of maintenance hemodialysis prior to enrollment 2.Core body temperature less than 35.0 degrees Celsius before dialysis 3.Clinical contraindications to dialysate cooling such as Raynaud's phenomenon or cold agglutinin disease 4.Hemodynamic instability requiring continuous vasopressor titration during dialysis 5.Inability to obtain accurate blood pressure measurements due to severe arrhythmia or other conditions 6.Pregnancy 7.Decline or withdraw consent to participate in the study 8.Core body temperature equal to or higher than 38.5 degrees Celsius before dialysis initiation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Incidence of intradialytic hypotension During each dialysis session, starting from initiation until the end of treatment Blood pressure measured every 15 minutes; hypotension defined as systolic drop by 20 mmHg or mean arterial pressure drop by 10 mmHg with symptoms or intervention. | — |
Secondary
| Measure | Time frame |
|---|---|
| Change in vasopressor dose during dialysis From 30 minutes before dialysis initiation until 30 minutes after dialysis completion Vasopressor dose recorded before, during, and after dialysis using standard infusion chart in micrograms per kilogram per minute,Session outcome recorded as completed or not completed in dialysis nursing record at the end of each dialysis session At the end of each dialysis session Session outcome recorded as completed or not completed in dialysis nursing record at the end of each dialysis session,Dialysis session recorded as terminated early in nursing documentation along with reason for discontinuation At the end of each dialysis session Dialysis session recorded as terminated early in nursing documentation along with reason for discontinuation,Incidence of adverse events related to temperature During each dialysis session Adverse events such as shivering or discomfort recorded by nurses during dialysis based on patient symptoms and clinical observation,Twenty eight day all cause mortality At 28 days after first dialysis session Vital status of patient recorded as alive or deceased based on hospital records and follow up at 28 days after dialysis initiation | — |
Countries
Thailand
Contacts
Public ContactTheerapun Boonsayomphu
Buriram Hospital
Outcome results
None listed