Q:  52 year old male with ESRD had out of hospital witnessed cardiac arrest. Patient survived CPR and has been started on hypothermia protocol in ER. Patient is now hypertensive. Potassium is under normal range. Cardiology requests to perform dialysis before angiogram. What is your concern performing hemodialysis (HD)?

Answer: Most HD machines warm blood before returning in to the patient. With most machines, the warmer only goes as low as 35 degrees Celsius. In other words, dialysis can inadvertently warm the patient up to this temperature (from the target temp of 32 degrees, per the hypothermia protocol). Fortunately, CRRT machines do have adjustable temp settings that goes down to 32 degrees, so that might be a better alternative. If HD is absolutely needed, dialysate should be cooled down to 32 - 34°C.