Peritoneal Dialysis Fluid Cooling and Cardio-Protective Effects

NCT04394780 | Completed

• 1 other identifier: 107280
• Study Type: interventional
• Target: 8
• Locations: 0 countries
• Sites: N/A

Brief Summary

The study team aimed to investigate the relationship between occlusive coronary artery disease, myocardial perfusion, and peritoneal dialysate temperature. In addition, the study team aimed to identify how abnormal myocardial perfusion in peritoneal dialysis (PD) patients is related to occlusive coronary artery disease, to identify factors associated with occlusive coronary artery disease in end-stage renal failure patients on PD. Finally, the study team identified factors associated with PD induced cardiac injury in end-stage renal failure patients on this dialysis modality. In order to assess the patients response to physiological stress and the functional relevance of their coronary artery disease, patients underwent assessment using dual energy contrast enhanced (DCE) CT assessment of coronary arteries and myocardial perfusion. An initial CT scan with administration of contrast established baseline information regarding the extent of coronary artery disease, fibrosis, and myocardial perfusion at rest. Following this, patients underwent pharmacological stress with the administration of adenosine and a repeat CT scan established the response to stress in terms of myocardial perfusion. On the second study visit patients were started on C-CAPD using peritoneal dialysate cooled to between 32-33 degrees centigrade, at a pre-determined and precisely controlled temperature for the 4 hour duration of C-CAPD. Subsequently, patients were injected with a pharmacological stressor in the form of adenosine. They then underwent DCE CT assessment of coronary arteries and myocardial perfusion as done in the first visit. The second CT scan took place following a PD dwell.

Conditions

Dialysis; Complications

Keywords

cooling; peritoneal dialysis; myocardial perfusion; myocardial heterogeneity

Outcome Measures

Primary Outcomes (2)

• Correlation between occlusive coronary artery disease and myocardial perfusion

  Investigate the correlation between occlusive coronary artery disease, myocardial perfusion, and peritoneal dialysate temperature. Patients will have a CT scan to measure perfusion (mL/min/g) after peritoneal dialysis

  The day of study visit 1, lasting for approximately 2 hours

• Correlation between occlusive coronary artery disease and myocardial perfusion

  Investigate the correlation between occlusive coronary artery disease, myocardial perfusion and peritoneal dialysate temperature. Patients will have a CT scan to measure perfusion (mL/min/g) after peritoneal dialysis

  The day of study visit 2, lasting for approximately 6 hours

Study Arms (2)

Peritoneal dialysis at 37 C

NO INTERVENTION

Patients underwent peritoneal dialysis with the standard temperature.

Peritoneal dialysis at 32 C

ACTIVE COMPARATOR

Patients started on continuous ambulatory peritoneal dialysis using a peritoneal dialysate cooled to between 32-33 degrees centigrade, at a pre-determined and precisely controlled temperature for the 4 hour duration treatment.

Procedure: cooling

Interventions

cooling PROCEDURE

First, patients underwent peritoneal dialysis (PD) at 37 C (standard temperature) and then patients underwent PD cooling. After each PD session, the patient had a CT scan for the study team to study myocardial perfusion at rest and after introduction of a pharmacological stressor.

Peritoneal dialysis at 32 C

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients having peritoneal dialysis treatment at least 6 times per week at home and followed at the London Health Sciences Centre
• Male and female, age=16 years old
• Patients listed for renal transplantation
• Residual renal function less than or equal to 750 mls per 24 hour period

You may not qualify if:

• Previous adverse reaction to intravenous contrast
• Allergy to adenosine - Patients with significant residual renal function (greater than 750mL/24 hours)
• Exposure to peritoneal dialysis for \<90 days prior to recruitment
• Ongoing spontaneous bacterial peritonitis (SBP)
• Severe heart failure (New York Heart Association grade IV) - Cardiac transplant recipients
• Mental incapacity to consent

Sponsors & Collaborators

• London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's: lead

Related Publications (18)

• Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int. 2003 Mar;63(3):793-808. doi: 10.1046/j.1523-1755.2003.00803.x.

  PMID: 12631061 RESULT

• Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009 May;4(5):914-20. doi: 10.2215/CJN.03900808. Epub 2009 Apr 8.

  PMID: 19357245 RESULT

• Boon D, Bos WJ, van Montfrans GA, Krediet RT. Acute effects of peritoneal dialysis on hemodynamics. Perit Dial Int. 2001 Mar-Apr;21(2):166-71.

  PMID: 11330561 RESULT

• Drueke TB, Massy ZA. Atherosclerosis in CKD: differences from the general population. Nat Rev Nephrol. 2010 Dec;6(12):723-35. doi: 10.1038/nrneph.2010.143. Epub 2010 Oct 26.

  PMID: 20978469 RESULT

• McIntyre CW. Effects of hemodialysis on cardiac function. Kidney Int. 2009 Aug;76(4):371-5. doi: 10.1038/ki.2009.207. Epub 2009 Jun 10.

  PMID: 19516249 RESULT

• Ragosta M, Samady H, Isaacs RB, Gimple LW, Sarembock IJ, Powers ER. Coronary flow reserve abnormalities in patients with diabetes mellitus who have end-stage renal disease and normal epicardial coronary arteries. Am Heart J. 2004 Jun;147(6):1017-23. doi: 10.1016/j.ahj.2003.07.029.

  PMID: 15199350 RESULT

• Selby NM, Fialova J, Burton JO, McIntyre CW. The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids. Nephrol Dial Transplant. 2007 Mar;22(3):870-9. doi: 10.1093/ndt/gfl654. Epub 2006 Nov 22.

  PMID: 17121785 RESULT

• Verbeke F, Van Biesen W, Pletinck A, Van Bortel LM, Vanholder R. Acute central hemodynamic effects of a volume exchange in peritoneal dialysis. Perit Dial Int. 2008 Mar-Apr;28(2):142-8.

  PMID: 18332449 RESULT

• Selby NM, Fonseca S, Hulme L, Fluck RJ, Taal MW, McIntyre CW. Automated peritoneal dialysis has significant effects on systemic hemodynamics. Perit Dial Int. 2006 May-Jun;26(3):328-35.

  PMID: 16722025 RESULT

• Barnes E, Dutka DP, Khan M, Camici PG, Hall RJ. Effect of repeated episodes of reversible myocardial ischemia on myocardial blood flow and function in humans. Am J Physiol Heart Circ Physiol. 2002 May;282(5):H1603-8. doi: 10.1152/ajpheart.00786.2001.

  PMID: 11959621 RESULT

• McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, Camici PG. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008 Jan;3(1):19-26. doi: 10.2215/CJN.03170707. Epub 2007 Nov 14.

  PMID: 18003765 RESULT

• Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009 Dec;4(12):1925-31. doi: 10.2215/CJN.04470709. Epub 2009 Oct 1.

  PMID: 19808220 RESULT

• Erlinge D. A Review of Mild Hypothermia as an Adjunctive Treatment for ST-Elevation Myocardial Infarction. Ther Hypothermia Temp Manag. 2011;1(3):129-41. doi: 10.1089/ther.2011.0008.

  PMID: 24717042 RESULT

• Gotberg M, Olivecrona GK, Engblom H, Ugander M, van der Pals J, Heiberg E, Arheden H, Erlinge D. Rapid short-duration hypothermia with cold saline and endovascular cooling before reperfusion reduces microvascular obstruction and myocardial infarct size. BMC Cardiovasc Disord. 2008 Apr 10;8:7. doi: 10.1186/1471-2261-8-7.

  PMID: 18402663 RESULT

• Chopp M, Knight R, Tidwell CD, Helpern JA, Brown E, Welch KM. The metabolic effects of mild hypothermia on global cerebral ischemia and recirculation in the cat: comparison to normothermia and hyperthermia. J Cereb Blood Flow Metab. 1989 Apr;9(2):141-8. doi: 10.1038/jcbfm.1989.21.

  PMID: 2921288 RESULT

• Jefferies HJ, Burton JO, McIntyre CW. Individualised dialysate temperature improves intradialytic haemodynamics and abrogates haemodialysis-induced myocardial stunning, without compromising tolerability. Blood Purif. 2011;32(1):63-8. doi: 10.1159/000324199. Epub 2011 Feb 24.

  PMID: 21346338 RESULT

• Odudu A, Eldehni MT, McCann GP, McIntyre CW. Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients. Clin J Am Soc Nephrol. 2015 Aug 7;10(8):1408-17. doi: 10.2215/CJN.00200115. Epub 2015 May 11.

  PMID: 25964310 RESULT

• Eldehni MT, Odudu A, McIntyre CW. Randomized clinical trial of dialysate cooling and effects on brain white matter. J Am Soc Nephrol. 2015 Apr;26(4):957-65. doi: 10.1681/ASN.2013101086. Epub 2014 Sep 18.

  PMID: 25234925 RESULT

MeSH Terms

Interventions

Cool-Down Exercise

Intervention Hierarchy (Ancestors)

Post-Exercise Recovery Techniques; Physical Therapy Modalities; Therapeutics; Rehabilitation; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Christopher W McIntyre, MD

  Western University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Every patient underwent peritoneal dialysis at 37 C and then at 32 C one week after.

Study Record Dates

• First Submitted: May 6, 2020
• First Posted: May 19, 2020
• Study Start: January 11, 2016
• Primary Completion: July 18, 2018
• Study Completion: December 18, 2019
• Last Updated: May 19, 2020

Record last verified: 2020-05

Data Sharing

• IPD Sharing: Will not share