Hemodialysis international. International Symposium on Home Hemodialysis最新文献

{"title":"Variations in Serum Albumin Levels Over Time in Patients Treated With Conventional Hemodialysis or Expanded Hemodialysis: A Cohort Study.","authors":"Juan C Castillo, Jasmin Vesga, Angela Rivera, Peter Rutherford, Ricardo Sanchez, Henry Oliveros, Bengt Lindholm, Mauricio Sanabria","doi":"10.1111/hdi.13232","DOIUrl":"https://doi.org/10.1111/hdi.13232","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoalbuminemia is a well-established risk factor for mortality in chronic hemodialysis (HD) patients. To evaluate the association of time-varying serum albumin with the type of dialyzer, we analyzed serum albumin over time in two cohorts of HD patients, one receiving HDx therapy enabled by the Theranova dialyzer and the other conventional HD with high-flux dialyzer (HF-HD).</p><p><strong>Methods: </strong>In this cohort study, 1092 prevalent adult HD patients (mean age 61 years; 62% men; 42% had diabetes; 19% had cardiovascular disease) at Renal Care Services Colombia undergoing either HDx therapy enabled by Theranova dialyzer (n = 559) or HF-HD (n = 533) were enrolled between September 1, 2017, and November 30, 2017, and then underwent repeated measurements of serum albumin for up to 48 months. Sociodemographic and clinical, and laboratory characteristics at baseline were recorded, and a repeated-measures analysis of variance (ANOVA) was conducted to examine differences in means of serum albumin at different time points. To evaluate the association between dialysis membrane and albumin levels during the follow-up, a linear panel regression analysis was performed, allowing control for imbalances in the cohorts of baseline clinical and demographic variables, as well as the time-dependent variables.</p><p><strong>Results: </strong>Mean albumin concentration remained above 3.8 g/dL and did not differ over time between HDx and HF-HD (p = 0.789). No association (p = 0.208) between serum albumin levels varying over time and the use of the Theranova dialyzer was found in the linear panel regression model. However, serum albumin was linked to both inflammatory and nutritional markers, including C-reactive protein, ratio of platelets to lymphocytes, and protein-energy wasting.</p><p><strong>Conclusion: </strong>Variations in serum albumin levels over time were associated with protein-energy wasting, inflammation, high age, vascular access, and hospitalizations, but not with the type of dialyzer.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Monitoring During Hemodialysis Using Bioimpedance: A Comparison of Changes in Resistance Between Different Body Segments.","authors":"Melanie K Schoutteten, Patrick van der Heijden, Astrid D H Brys, Bart De Moor, Chris van Hoof, Geert Langereis, Jeroen P Kooman, Pieter M Vandervoort","doi":"10.1111/hdi.13245","DOIUrl":"https://doi.org/10.1111/hdi.13245","url":null,"abstract":"<p><strong>Introduction: </strong>Prevention of hemodynamic complications during hemodialysis remains challenging. Although whole body bioimpedance is well established in fluid status assessment, its use for dynamic or continuous recordings is limited. A segmental approach may serve this purpose better. This study investigates which body segment is best targeted to measure bioimpedance for hemodynamic monitoring.</p><p><strong>Methods: </strong>In this observational study, serial bioimpedance measurements were conducted on the whole body, lower leg, upper arm, and thorax of 15 patients during two hemodialysis sessions. The resistance component of bioimpedance was used to investigate the relationship with changes in volume and systolic blood pressure (SBP).</p><p><strong>Findings: </strong>Predialysis to postdialysis changes in relative resistance between the two sessions revealed the lowest intraclass correlation coefficient for upper arm (0.023) and the highest for thoracic resistance (0.728). Correlation between ultrafiltration volume and relative resistance was comparable between upper arm and thoracic segment (0.538 [0.447-0.618] and 0.537 [0.446-0.617], both p < 0.001, respectively) and the highest for whole-body and lower leg (0.697 [0.63-0.754] and 0.670 [0.598-0.731], both p < 0.001, respectively). In contrast, the correlation between changes in SBP and relative resistance was the highest in the thoracic segment (-0.33 [-0.432 to -0.219], p < 0.001) and the lowest for whole body measurements (-0.154 [-0.269 to -0.036], p = 0.01). In addition, multiple regression analysis indicated thoracic resistance as the best predictor for changes in SBP (β = -0.261 [-0.353 to -0.126], p < 0.001).</p><p><strong>Discussion: </strong>These findings suggest that the thorax is the most suitable region for segmental bioimpedance measurements to assess hemodynamic parameters. Thoracic bioimpedance may innovate the hemodynamic monitoring of hemodialysis patients.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Long-Term Patency Rate and Factors Influencing Dysfunction of the Autogenous Arteriovenous Fistula in Hemodialysis Patients: A Retrospective Study.","authors":"Qinghua He, Yu Zhou, Chen Chen, Baojia Zheng, Jingjing Zhang, Fulan Wang","doi":"10.1111/hdi.13246","DOIUrl":"https://doi.org/10.1111/hdi.13246","url":null,"abstract":"<p><strong>Introduction: </strong>Autogenous arteriovenous fistula (AV fistula) dysfunction continues to be a widespread clinical challenge, adversely impacting both patients and society as a whole. The aim of this study was to investigate the long-term patency rate of AV fistula, explore the factors that contribute to AV fistula dysfunction, and present the findings in a way that can guide clinical practice.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled patients who underwent AV fistula creation and subsequent hemodialysis at a tertiary A-level hospital in Chongqing, China. Demographic, clinical, and laboratory characteristics of the patients, as well as AV fistula dysfunction, were retrospectively reviewed from electronic health records. Cox proportional hazards regression analysis was used to analyze the factors influencing AV fistula dysfunction, and a forest plot was created to visualize the results. Additionally, Kaplan-Meier survival analysis was used to analyze AV fistula survival.</p><p><strong>Findings: </strong>This study analyzed 226 patients undergoing hemodialysis, demonstrating cumulative AV fistula patency rates of 82.1% at 12 months, 60.7% at 36 months, 45.4% at 60 months, and 33.5% at 84 months. Univariate Cox proportional hazard regression analysis identified six variables associated with AV fistula dysfunction (p < 0.1): body mass index (BMI), preemptive AV fistula creation, diabetes, total cholesterol, albumin, and uric acid. Subsequent multivariate analysis revealed four independent predictors for dysfunction: elevated BMI (HR: 1.58, p = 0.016), preemptive AV fistula creation (HR: 0.67, p = 0.029), albumin (HR: 2.83, p < 0.001), and uric acid (HR: 1.57, p = 0.020).</p><p><strong>Discussion: </strong>Our study findings indicated that overweight, hypoalbuminemia, and high concentrations of uric acid were independent risk factors for AV fistula dysfunction. In contrast, preemptive AV fistula creation was an independent protective factor against AV fistula dysfunction. Therefore, early interventions and surveillance for these factors should be performed to improve long-term AV fistula patency rates.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Massive Hemothorax Induced by Tunneled Dialysis Catheter Placement via the Left Internal Jugular Vein: A Case Report.","authors":"Ping Shi, Mengyue Zhu, Yi Zhang, Jun Xu, Hongbin Mou","doi":"10.1111/hdi.13244","DOIUrl":"https://doi.org/10.1111/hdi.13244","url":null,"abstract":"<p><p>The tunneled dialysis catheter is among the most commonly used vascular accesses for patients undergoing hemodialysis. Delayed hemothorax resulting from central venous perforation induced by catheterization is a rare but serious complication. However, there are few reports. This article reports the case of a 79-year-old male who developed delayed massive hemothorax following catheter placement via the left internal jugular vein. The condition was successfully managed with closed thoracostomy and conservative therapy. This case underscores the potential for delayed hemothorax after tunneled dialysis catheter placement, emphasizing the need for heightened vigilance during the immediate post-procedural period. Close monitoring in the first hours after catheterization is critical to enable early detection, prompt recognition, and timely intervention for such complications.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Illness Adaptation and Type D Personality in Hemodialysis Patients.","authors":"Berna Akay, Canan Bozkurt, Nurdan Sahin","doi":"10.1111/hdi.13243","DOIUrl":"https://doi.org/10.1111/hdi.13243","url":null,"abstract":"<p><strong>Introduction: </strong>Although the impact of Type D personality on individuals with various chronic health conditions has been widely studied, its role in hemodialysis patients remains unclear. This study aimed to explore the relationship between illness adaptation and Type D personality in hemodialysis patients and to examine the sociodemographic and clinical characteristics that influence illness adaptation.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in hemodialysis units in western Turkey from November 2021 to November 2022. Data were collected using a Personal Information Form, the Adaptation to Chronic Illness Scale, and the Type D Personality Scale. Descriptive statistics, t-tests, ANOVA, Pearson's correlation, and multivariate linear regression analysis were applied to analyze the data.</p><p><strong>Results: </strong>A total of 138 hemodialysis patients participated in the study. The mean score for adaptation to chronic illness was 80.6 ± 13.6. Among these patients, 38.4% had Type D personality. A negative correlation was found between illness adaptation and Type D personality (r = -0.683, p < 0.001). Regression analysis revealed that Type D personality (β = -0.255), gender (β = -0.087), age (β = 0.137), education level (β = 0.152), economic status (β = 0.177), and hemodialysis duration (β = 0.307) were significant predictors of illness adaptation.</p><p><strong>Conclusion: </strong>Healthcare providers should offer individualized psychosocial care and counseling services to enhance illness adaptation in hemodialysis patients. In particular, strategies to improve adaptation should be tailored for patients with Type D personality traits.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetics of Metronidazole During Prolonged Intermittent Kidney Replacement Therapy.","authors":"Jessica H Xu, Vesa Cheng, Matthew Rawlins, David Morgan, Hayoung Won, Xiaolin Wu, John Dyer, Jason A Roberts","doi":"10.1111/hdi.13242","DOIUrl":"https://doi.org/10.1111/hdi.13242","url":null,"abstract":"<p><p>Acute kidney injury is a common complication present in critically ill patients and is often managed by kidney replacement therapy. Prolonged intermittent kidney replacement therapy (PIKRT) is a modality of kidney replacement therapy often utilized in intensive care settings, but dosing recommendations and pharmacokinetic data for antimicrobial removal during PIKRT are limited. Metronidazole, a 5-nitroimidazole agent, is commonly prescribed for anaerobic and protozoal infections. Although generally well tolerated, adverse effects including severe neurotoxicity have been reported in association with prolonged or high cumulative dosing, particularly in the setting of kidney or hepatic impairment. In this case study, we describe and discuss the pharmacokinetics of metronidazole and the hydroxy-metabolite (hydroxy-metronidazole) concentrations in a critically ill patient undergoing PIKRT.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Long-Term Effects of Parathyroidectomy in Patients With Refractory Secondary Hyperparathyroidism.","authors":"Liu Yang, Nian-Rong Zhang, Hai-Feng Wang, Jing-Ning Chen, Meng Yang, Xiao-Liang Sun, Yong Lv, Yao Lu, Wan-Ning Jia, Wen-Wen He, Ling Zhang","doi":"10.1111/hdi.13222","DOIUrl":"https://doi.org/10.1111/hdi.13222","url":null,"abstract":"<p><strong>Objective: </strong>Parathyroidectomy is an effective intervention for patients with end-stage renal disease and refractory secondary hyperparathyroidism. This study aimed to assess the long-term clinical outcomes and overall quality of life of patients following parathyroidectomy in real-world clinical practice.</p><p><strong>Methods: </strong>The study included 103 patients with refractory secondary hyperparathyroidism treated with parathyroidectomy in a real-world setting (51 males, age 58 ± 10 years). Intact parathyroid hormone (iPTH), serum calcium, and serum phosphorus indices were compared preoperatively and at 6 months, 12 months, and 1 year postoperatively. The proportion of patients with a > 30% decrease in iPTH was evaluated to assess the long-term treatment effect of parathyroidectomy. The EQ-5D-5L scale was utilized to evaluate the long-term postoperative quality of life.</p><p><strong>Results: </strong>Fifty percent of the patients included in the study had a follow-up time of more than 19 months (19.0 [12.0, 24.0]). The median pretreatment iPTH level was 1796.2 (905.5, 2909.8) pg/mL, with 43.7% of patients exceeding 2000 pg/mL and 19.4% exceeding 3000 pg/mL; 19 (18%) patients had an iPTH level of ≤ 800 pg/mL. The preoperative mean serum calcium level was 2.54 (0.22), 95% CI (2.44, 2.68), and the mean serum phosphorus level was 2.09 (0.48), 95% CI (1.81, 2.19). Approximately 50% of patients underwent total parathyroidectomy. The iPTH levels decreased significantly after surgery (p < 0.001). At 6 months postoperatively, 96.7% of the patients had a decrease in iPTH of more than 30% compared to the preoperative levels, and this percentage was 94.9% at 12 months postoperatively. Mean serum calcium and phosphorus levels decreased significantly after surgery (p < 0.01). More than 60% of patients achieved target serum calcium levels, and more than 40% achieved target serum phosphorus levels at 6 months postoperatively, demonstrating a statistically significant increase compared to preoperative levels (p < 0.001). No significant difference in surgical outcomes was observed between the groups with preoperative iPTH levels > 800 and < 800 pg/mL. The utilization of secondary hyperparathyroidism-related medications decreased following surgical intervention. The median health utility value, as measured using the EQ-5D-5L scale, was 0.897 (0.739, 1.0), with a median VAS score of 80 (60, 90).</p><p><strong>Conclusions: </strong>In clinical practice, parathyroidectomy demonstrates efficacy in reducing iPTH levels and facilitating the management of serum calcium and phosphorus levels. Moreover, this surgical intervention significantly decreases medication requirements and enhances the long-term quality of life for patients postoperatively. The evidence suggests that surgical intervention may confer long-term benefits to patients with refractory secondary hyperparathyroidism.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodialysis and Water Management in a Dialysis Unit in Morocco, an Approach to Dealing With Water Scarcity.","authors":"I Haddiya, I Melhaoui, A El Khalifi, S Ramdani, Y Bentata, F Z Berkchi","doi":"10.1111/hdi.13241","DOIUrl":"https://doi.org/10.1111/hdi.13241","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease is a global public health issue, affecting approximately 10% of the world's population, and more than 3 million people living with kidney failure who are estimated to be on maintenance dialysis programs, with the majority receiving hemodialysis (HD). This treatment is particularly water-intensive, posing a considerable challenge in regions experiencing water scarcity, such as Morocco.</p><p><strong>Methods: </strong>Our HD center in Oujda, Eastern Morocco, has implemented several key strategies to address water scarcity and ensure uninterrupted HD procedures during periods of hydric stress.</p><p><strong>Results: </strong>These strategies include expanding water storage capacities to safeguard against shortages, upgrading infrastructure to enhance water efficiency, and employing innovative technology for real-time monitoring and management of water resources. Additionally, we collaborate closely with local water authorities to secure reliable water supplies and explore possibilities for water regeneration and recycling.</p><p><strong>Discussion: </strong>The rising demand for clean water, coupled with its increasing scarcity, presents a significant challenge for healthcare systems, particularly in the context of HD. Therefore, innovative approaches are essential to mitigate this issue. The concept of green dialysis, which focuses on reducing water usage and minimizing environmental impact, is emerging as a promising solution with measurable benefits. Implementing water-efficient reverse osmosis systems has resulted in significant reductions in water waste, while real-time monitoring and early warning systems have enhanced water security and operational efficiency. Additionally, initiatives exploring the reuse of reject water hold potential for further conservation. These tangible outcomes demonstrate how green dialysis practices can contribute to sustainable HD treatment, ensuring uninterrupted patient care, reduced resource consumption, and improved environmental stewardship in water-scarce regions.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitude of Healthcare Professionals and Patients With End-Stage Kidney Disease Towards Home Hemodialysis: A Survey in China.","authors":"Junqing Liang, Ying Wang, Hongjie Yang, Yongju Jin, Li Zuo","doi":"10.1111/hdi.13197","DOIUrl":"https://doi.org/10.1111/hdi.13197","url":null,"abstract":"<p><strong>Introduction: </strong>Home hemodialysis is still in its early stages in mainland China. This survey aimed to assess the perceptions of healthcare professionals and patients towards home hemodialysis and to identify the barriers hindering its uptake.</p><p><strong>Methods: </strong>A cross-sectional observational survey was conducted using convenience sampling. Healthcare professionals specializing in nephrology and patients with end-stage kidney disease (ESKD) across mainland China were included. A self-reported questionnaire was administered to gather data on participants' demographics, attitudes, perceived barriers, and facilitating factors related to home hemodialysis. Chi-square tests were used to analyze the association between categorical variables.</p><p><strong>Findings: </strong>A significant majority (80.1%) of healthcare professionals recognized the need for home hemodialysis. However, there was a statistically significant difference in willingness to undertake or receive home hemodialysis between healthcare professionals (53.6%) and patients (63.2%), respectively. Healthcare professionals identified the following as top facilitating factors: patients' needs (6.9 points), higher patient benefits (5.7 points), and shortage of dialysis resources (5.1 points). The primary barriers cited were the absence of relevant policies and regulations (7.5 points), lack of guidelines and management standards (7.0 points), and inadequate treatment technology and knowledge (6.6 points). Patients' willingness to accept home hemodialysis was primarily driven by the potential to save time and travel expenses (70.7%) and reduce infection risk (49.0%). The main barriers identified by patients were the inability to manage acute complications (77.8%), increased risk of vascular access infection (66.1%), and uncertainty about self-cannulation (60.7%).</p><p><strong>Conclusion: </strong>There is a clear demand for home hemodialysis in China among both healthcare professionals and patients with ESKD. However, the lack of a supportive system, including policies, standards, and management frameworks, remains a significant obstacle to its widespread adoption.</p>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"https://doi.org/10.1111/hdi.13233","url":null,"abstract":"<p><strong>Background: </strong>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><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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).</p><p><strong>Conclusions: </strong>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>","PeriodicalId":94027,"journal":{"name":"Hemodialysis international. International Symposium on Home Hemodialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}