Conventionally, dialysis centres have provided hemodialysis using a standard dialysis fluid temperature of 36.5°C for all patients. Preliminary evidence showed that using a cooler dialysis fluid may have cardiovascular benefits. Based on this, a growing number of centres are using a cooler temperature of 36°C or lower in patient care. The trial was conducted to examine whether providing dialysis using a cooler dialysis fluid reduced the risk of cardiovascular-related hospital admission or death compared with using a standard temperature of 36.5°C.

The MyTEMP Trial

The MyTEMP trial team was led by Dr. Amit X. Garg , a nephrologist at the London Health Sciences Centre and Professor of Medicine, Epidemiology and Biostatistics at Western University. The trial, conducted from 2017 to 2021, randomized 84 of Ontario’s 97 hemodialysis centres into one of two groups. In one group, the team set dialysis fluid temperature to 0.5°C below each patient’s body temperature (referred to as personalized cooler dialysate). In the other group, the team set the temperature to 36.5°C for all patients (referred to as standard temperature dialysate).

The researchers used several innovative methods to conduct this trial, including:

• Integrating the intervention into routine care with minimal to no healthcare disruption for patients or staff.
• Including all patients at the 84 centres in the trial.
• Making use of routinely collected data from existing administrative health data sources to reliably assess outcomes.

MyTEMP became the largest trial of maintenance hemodialysis published to date. It included over 95% of patients receiving hemodialysis in Ontario during the trial period. This totaled more than 15,000 patients who had more than 4.3 million dialysis treatments.

The trial resulted in three publications:

• The MyTEMP Protocol

• The MyTEMP Statistical Analysis Plan

• The MyTEMP Findings

“What’s remarkable about the MyTEMP trial is the methods we used. Because we embedded the trial into existing healthcare at nearly all hemodialysis centres in Ontario, we were able to determine whether the intervention would improve outcomes in a real-world setting that represented all patients who receive hemodialysis in routine care.”

– Dr. Amit X. Garg

MyTEMP’s Findings

At the end of the trial, the MyTEMP team examined how many patients had cardiovascular-related hospitalizations or deaths in each group. They found that adopting a centre-wide policy of personalised cooler dialysate did not reduce the risk of major adverse cardiovascular events or death. Also, patients in the personalised cooler dialysate group were more likely to report feeling cold on dialysis than respondents in the standard-temperature group.

As a result, the team concluded that the intervention lacked measurable benefit. This was compounded by the likelihood of patient discomfort. Thus, the team concluded that cooler dialysate should not be adopted as a centre-wide policy.

“Based on the trial’s findings, dialysis centres that are currently providing cooler dialysate as a centre-wide policy should consider using a dialysate temperature of 36.5°C as their standard for the comfort of their patients,” said Dr. Garg. “The role of cooler dialysate in the management of specific types of patients who have frequent episodes of low blood pressure during dialysis now needs to be clarified in future studies.”