The study of effect lowering the dialysate temperature on hemodynamic indicators and dialysis efficiency of the diabetic patients in aliabn abitalb (AS) hospital of zahedan university of medical sciences in 2018

1. Determination and comparison the mean of systolic blood pressure in the routine and cold dialysis methods, before dialysis, at 1, 2, 3 hours during dialysis and after dialysis. 2. Determination and comparison of diastolic blood pressure in the routine and cold dialysis methods, before dialysis, at 1, 2, 3 hours during dialysis and after dialysis. 3. Determination and comparison of arterial blood pressure in the routine and cold dialysis methods, before dialysis, at 1, 2, 3 hours during dialysis and after dialysis. 4. Determination and comparison of mean Heart rate in the routine and cold dialysis methods, before dialysis, at 1, 2, 3 during dialysis and after dialysis.  5. Determination and comparison the temperature of patients undergoing dialysis treatment in the routine and cold dialysis methods, before and after hemodialysis. 6. Determination and comparison the adequacy of dialysis in patients undergoing hemodialysis in the routine and cold dialysis methods, before and after hemodialysis.

In this study, 32 hemodialysis patients are selected availably according to the available entry conditions, which are referred to hemodialysis department of Ali ebn Abitalib Hospital in Zahedan. The study phase does not apply to this study.

In this study, 32 hemodialysis patients are selected availably and non-randomly, with inclusion criteria, who are referred to hemodialysis unit of Ali ebn Abitalib hospital in Zahedan. Essential descriptions of how the study is conducted and the purpose of the study is given to patients who are asked to read and sign the written consent form and then with regard to age, gender, occupation, education, and compliance with medical ethics and safety, we complete the demographic information of the patients. Patients undergo hemodialysis in two sessions, once with a cold solution (36 ° C) and the next session with a routine or conventional solution (37 ° C). The hemodialysis variables except for temperature are the same in both cases. The hemoglobin is warmed up to 36.5 to 37.5 ° C (normal range) before the hemodialysis. All patients have one type of dialyser and a dialysis solution (with bicarbonate ) will be used. In the beginning, all machines are verified for the correctness of the function. In order to harmonize the conditions in this study, the rate of fluid harvesting for each patient is determined based on the weight difference before the patient's pure weight loss. The ambient temperature (23 ° C) is controlled throughout the study. The concentration of sodium fluid in dialysis is constant in all sessions. Blindness does not apply to this study.

Inclusion Criteria: Having a history of hemodialysis at least three months before the study, not taking low blood pressure medications, patients weighing less than 2 kg, those who had reached a systolic pressure of less than 90 mm Hg in their previous dialysis sessions and experienced related symptoms with it, having no severe anemia (>8Hb) , no malignancy, no thyroid abnormalities. Exclusion criteria: Patient's death, dialysis immaturity with a cold solution (in case of very severe chills), food and fluid intake exceeds the amount prescribed during dialysis, unwillingness to continue to participate in the study.

The study is conducted in 2018. All patients who undergo dialysis 3 times a week and 3-4 hours each are included in the study. The hemodialysis fluid flow rate is constant at 500 mm / min with a Fresenius 4008-B apparatus and the same ultrafiltration with the same filtration rate, which is constant for all patients during the study. The fluid withdrawal rate for each patient was calculated before the dialysis weight was calculated with the patient's dry weight and the machine's total weight The accuracy and accuracy of the device, blood pressure, and blood pressure of 8 patients are measured 5 times in a 5-minute sitting period. The systolic and diastolic blood pressure of the patients is measured by a digital doped barometric In the early stages of dialysis, during the first, second and third days of dialysis, and immediately after the end of dialysis, the patient's heart rate is measured at the same time as the blood pressure and the same device. Before and after After each dialysis session, the temperature of the mufflers is measured and recorded. In addition, if the patient complains at least one of the symptoms of hypotension, such as muscle cramps, nausea, vomiting, fatigue and dizziness, his blood pressure will be measured at the same time. The number of times the pressure drop and the changes in pressure and number of actions are necessary. In order to heal, the difference in blood pressure is the difference between the systolic and diastolic blood pressure during dialysis, as well as systolic and diastolic blood pressure, and the onset of dialysis. The mean arterial pressure (MAP) is calculated from the sum of systolic and dihidrostheol divided by 3 times. The patient's time is hypotension, with systolic blood pressure lower than 90 mm Hg. In patients whose baseline blood pressure is 100-90 mm Hg , A 25% drop or a decrease of 20 mm in excess of systolic pressure as hypotension. Dialysis adequacy means that dialysis takes up 70% or more of blood urea over a 4-hour dialysis period, and subsequent administration of dialysis should be based on a higher or at least 70% withdrawal rate. The procedure is that in the final dialysis session before dialysis immediately after insertion of the catheter into the patient's artery Also, at the end of the same dialysis session, the blood flow rate was reduced to 100 ms / min for 10 seconds, and blood samples were taken before and after dialysis for measurement of urea, creatinine, sodium and potassium, and sent to the laboratory. The above tests are routine The monthly is done in the dialysis department Rabbo importance of maintaining the level of serum sodium, potassium, dialysis patients these tests along with urea and creatinine is measured.   100 * urea pre-dialysis / urea dialysis lateral dialysis = URR To calculate the adequacy of dialysis, we use the second generation of Dagridas formula, which is an acceptable formula of the world. In this formula, the natural logarithm, the duration of each hemodialysis session per hour, the proportion of urea after dialysis to pre-dialysis, the weight of the dialysis and the volume of the ultrasound Filtration is on.  KT / V = ​​1.2 100. Urea pre-dialysis / urea dialysis after previous dialysis = URR KT / V = ​​-Ln (R-0/008 × T) + (4--3 / 5T) × 0 / 55UF / V KT / V = ​​Ln (1-URR) It should be noted that according to the division of tasks, data recording, group assignment and their matching are done by the student. Performing dialysis, blood pressure measurements and sampling by nurse, researcher and researcher. Advice and guidance will be provided at all stages by advisor professors.

hemodynamic indicators ,dialysis efficiency

Only the original outcome data will be available

After publishing the article in 2018

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Improve treatment conditions

Zahedan University of Medical Sciences

Applying from the university research vice president