Dawn F. Wolfgram, Isabelle Grassl, Claire Seigworth, Michael E. Widlansky, Yan Gao
{"title":"Cerebrovascular Reactivity and Cerebral Ischemia During Chronic Hemodialysis","authors":"Dawn F. Wolfgram, Isabelle Grassl, Claire Seigworth, Michael E. Widlansky, Yan Gao","doi":"10.1111/hdi.13233","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Cerebral hypo-perfusion during hemodialysis (HD) may contribute to cerebral ischemic lesions and atrophy in HD patients. Vascular disease and stiffness can impair cerebrovascular reactivity (CVR) in HD patients, placing them at higher risk for cerebral hypo-perfusion during the hemodynamic stress of HD. We evaluated the relationship between CVR and change in cerebral perfusion during HD.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In a cohort of in-center HD patients, we used hypercapnia to induce a change in cerebral blood flow velocity measured with transcranial Doppler to assess CVR. We used continuous cerebral oximetry during HD to measure a change in cerebral oxygen saturation (ScO<sub>2</sub>), calculating overall decline and the largest drop as markers of cerebral perfusion. We used multiple linear regression to assess the relationship between CVR and the ScO<sub>2</sub>-associated endpoints.</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>We measured CVR in 42 HD patients and of those, 41 had the ScO<sub>2</sub> measurements completed. The mean age was 58.5 (11.0) years, and most were male (90.5%, <i>N</i> = 38) with diabetes (59.5%, <i>N</i> = 25) and hypertension (87.5%, <i>N</i> = 36). The average CVR was 2.7 (1.6)%/mmHg. The average overall decline in ScO<sub>2</sub> during HD was 2.2 (2.5)% and the average largest drop in ScO<sub>2</sub> was 5.9 (2.8)%. CVR was negatively associated with both the largest drop in ScO<sub>2</sub> (<i>β</i> = −0.67 95% CI [−1.20, −0.15], <i>p</i> = 0.01) and the overall decline in ScO<sub>2</sub> (<i>β</i> = −0.62 95% CI [−1.09, −0.15], <i>p</i> = 0.01). Vascular disease was a risk factor for lower CVR (<i>β</i> = −1.21, 95% CI [−2.16, −0.26] <i>p</i> = 0.01).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>A lower CVR increases the risk for cerebral hypo-perfusion during HD. Impaired CVR may be an important part of the pathophysiology of ischemic brain injury and cognitive impairment in HD patients.</p>\n </section>\n </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 3","pages":"346-353"},"PeriodicalIF":1.2000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hemodialysis International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hdi.13233","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Cerebral hypo-perfusion during hemodialysis (HD) may contribute to cerebral ischemic lesions and atrophy in HD patients. Vascular disease and stiffness can impair cerebrovascular reactivity (CVR) in HD patients, placing them at higher risk for cerebral hypo-perfusion during the hemodynamic stress of HD. We evaluated the relationship between CVR and change in cerebral perfusion during HD.
Methods
In a cohort of in-center HD patients, we used hypercapnia to induce a change in cerebral blood flow velocity measured with transcranial Doppler to assess CVR. We used continuous cerebral oximetry during HD to measure a change in cerebral oxygen saturation (ScO2), calculating overall decline and the largest drop as markers of cerebral perfusion. We used multiple linear regression to assess the relationship between CVR and the ScO2-associated endpoints.
Findings
We measured CVR in 42 HD patients and of those, 41 had the ScO2 measurements completed. The mean age was 58.5 (11.0) years, and most were male (90.5%, N = 38) with diabetes (59.5%, N = 25) and hypertension (87.5%, N = 36). The average CVR was 2.7 (1.6)%/mmHg. The average overall decline in ScO2 during HD was 2.2 (2.5)% and the average largest drop in ScO2 was 5.9 (2.8)%. CVR was negatively associated with both the largest drop in ScO2 (β = −0.67 95% CI [−1.20, −0.15], p = 0.01) and the overall decline in ScO2 (β = −0.62 95% CI [−1.09, −0.15], p = 0.01). Vascular disease was a risk factor for lower CVR (β = −1.21, 95% CI [−2.16, −0.26] p = 0.01).
Conclusions
A lower CVR increases the risk for cerebral hypo-perfusion during HD. Impaired CVR may be an important part of the pathophysiology of ischemic brain injury and cognitive impairment in HD patients.
期刊介绍:
Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis.
The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.