Isothermic vs thermoneutral hemodiafiltration evaluation by indirect calorimetry

HD and HDF as hemodialytic therapies normally alter patient's haemodynamic stability, due to the inflammatory response to extracorporeal blood circuit, producing increment of the core temperature (+1.0 °C). However, such increase in temperature could be controlled by lowering dialysate's temperature using two main modalities techniques (isothermic and thermoneural) with different patient's thermal balance consequences, not yet well studied. In this work, energy expenditure (EE) was measured by indirect calorimetry in a group of 12 patients waiting kidney transplant. In each patient, EE was assessed (as a power generation) during isothermic and thermoneutral modalities as a manner of cross and prospective study (a) at before therapy, (b) during therapy and (c) at the end of the HDF therapy. Wheraeas, power extraction was measured by a BTM (Blood Temperature Monitor from Fresenius Inc) in order to determine power balance in a thermodynamic model of the extracorporeal circuit. The results showed significant differences in the power balance when EE at during therapy was subtracted from the EE at before therapy. Then, EE increments were 32 Kcal/4-hours during isothermic and 3.6 Kcal/4-hours during thermoneutral HDF sessions (p < 0.05). While, BTM totals power extraction was 91 and 16.1 Kcal/4-hours (p<0.05), respectively. Additionally, it was estimated a 12 % of EE/day increment during HDF-isothermic at during therapy stage compared with none significative EE increment during thermoneutral modality. The statistical evidence confirmed the expected hypothesis that both modalities affect in different manner the patient's EE. Also, we conclude there is no satisfactory data interpretation when the thermodynamic model was applied expecting null balance between EE increment and BTM power extraction. Therefore, these findings force to think there is need of different BTM design and measurement setting with ability to follow dynamic patient's EE changes with the purpose to achieve a better power balance.