الفهرس 
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Abstract
Cooling dialysate first came into practice three decades ago after it was noted to decrease the symptoms of patients suffering from IHD on dialysis. Since then, many benefits of cooled dialysate temperatures have come to light. Multiple studies have demonstrated improved hemodynamic tolerance on dialysis specifically in patients prone to IDH without any adverse effect on dialysis adequacy. It is an inexpensive intervention that also reduces the frequency of nursing involvement with IDH in patients on chronic hemodialysis. While the cooler temperatures may cause discomfort in some patients, a temperature of 0.5°C below an individual’s CBT is better tolerated than an arbitrary temperature of 35°C. The current work aimed to study the effect of cool dialysate on inflammatory and nutritional status in patients on maintenance hemodialysis. The present study was carried out on seventy patients treated by chronic hemodialysis for six months or more in Mansoura Nephrology and Dialysis Unit. The enrolled patients were divided into 2 groups. The first group (group A) were subjected to cooled dialysate (n=30). The second group (group B): were treated by the standard non cooled dialysate (n=40). Medical history taking and basic laboratory investigations (blood hemoglobin, serum TSAT, ferritin, calcium, phosphorus and PTH) were performed. In addition, dialysis adequacy measured by KT/V, as well as serum Interleukin-6, high-sensitive CRP and ESR levels were investigated. Moreover, anthropometric measurements and Malnutrition Inflammation Score were calculated. At the start of the study, the demographic and clinical data did not show statistically significant differences between both groups. Similarly, the two groups were not statistically significantly different regarding the anthropometric data. At the end of the study, the laboratory parameters of the two study groups did not reveal statistically significant differences between them except for serum ferritin that was significantly higher in patients of the cooled dialysate group. After six months of dialysate cooling, the patients of the intervention group showed statistically significantly decreased frequency of IDH; an observation that was not shared with the non-intervention group. Moreover, the group with dialysate cooling showed statistically significantly increased albumin and decreased ferritin, Hs-CRP and IL-6, denoting beneficial effects on nutrition and inflammation. However, the same group displayed significant increase in ESR and decrease in hemoglobin and TSAT after the six-month intervention duration, which contradict the latter findings. It was disappointing to find that the non-intervention group showed a parallel patten of changes, except for the Hs-CRP which increased significantly after the six-month follow-up duration in the non-dialysate cooling group; thus, reflecting a differential beneficial effect of dialysate cooling. In addition to the above-mentioned findings, there were no significant changes in the anthropometric data in both groups of patients, while there was significant deterioration of the MIS in both after the six-month duration of observation. The manoeuvre of dialysate cooling was not free of side effects, as there was statistically significant increase in the frequency of shivering and discomfort; although none of them was severe enough to persuade the patient to withdraw from the study.