Freely Filtered 056: MyTEMP

In the latest episode we chill out and discuss why it may not be necessary to make patients uncomfortably cool to prevent cardiovascular badness.

The Filtrate:

Joel Topf

Swapnil Hiremath

Nayan Arora

Sophia Ambruso

With Special Guest:

Amit Garg @AmitXGarg, Nephrologist at Western University, London, and lead PI of the MYTEMP trial. 

Editor:

Joel Topf

Show Notes:

MyTEMP in pubmed: Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial

MyTEMP Summary on NephJC 

It’s really cold in Ontario

The NephTrials blog summary on Pragmatic Trials

The pragmatic TiME trial on longer time on dialysis (ahem, sabotaged by site investigators like Joel who cut dialysate time) Dember et al in JASN

Poor quality of trial data preceding MyTEMP, a systematic review from Mustafa et al in JASN 

The 2007 European Best Practice Guideline (EBPG) from 2007, recommending “Cool dialysate temperature dialysis (35–36°C) or isothermic treatments by blood temperature controlled feedback should be prescribed in patients with frequent episodes of IDH (Evidence level I).” in NDT

47% of centres from a DOPPS study of 273 centers routinely use of lower dialysate temperature, Dasgupta et al in JASN

How do you convert from C to F? Almanac.com (35.5 C is 96.9 F; 37 C is 98.6 F)

More on the rationale and design of MyTEMP: Al-Jaishi et al in CJKHD

How big is 4.3 million (the number of hemodialysis treatments in MyTEMP)? Very big indeed.

NephJC discussion of another cluster RCT and granular data only on a subset SSASS 

Participants in dialysis clinical trials are not representative of the real world dialysis cohorts, Smyth et al in JAMA Int Med

Peritoneal dialysis numbers in Ontario are high, Blake et al in PDI, though with ~ 60% CVC rates, Blake et al in Kidney360

Dialysate Magnesium #DreamRCT from Swap, NephTrials discussion of DialMag

Statistical analysis plan of MyTEMP, Dixon et al in CJKHD

Tubular Secretions

Swap: Watch Everything, Everywhere All At Once on Prime

Nayan: Read The Midnight Ride from Ben Mezrich (brother of Josh Mezrich from the NephJC Summer Book Club 2021)

Sophia: Making nephrology education fun at the UC Denver

Amit: The wrestling team at Western U from 1990-91; Register here for the 2023 Gardener’s Grove conference

Joel: House of the Dragon on HBO Max