{"title":"慢性肾病患者动静脉内瘘对脑氧合的影响。","authors":"Yuko Mutsuyoshi, Kiyonori Ito, Susumu Ookawara, Yuichiro Ueda, Mitsutoshi Shindo, Momoko Hirata, Hiroaki Nonaka, Junki Morino, Shohei Kaneko, Taisuke Kitano, Haruhisa Miyazawa, Keiji Hirai, Yoshiyuki Morishita","doi":"10.1177/11297298241257431","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Vascular access, including arteriovenous fistula (AVF), is essential in patients undergoing hemodialysis (HD). However, the presence of AVF is non-physiological in humans and could pose a burden to the systemic circulation or tissue microcirculation, potentially affecting tissue oxygenation, including in the brain. Recently, near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO<sub>2</sub>) as a marker of cerebral oxygenation in various settings, including in patients undergoing HD. Thus far, no studies have reported changes in cerebral rSO<sub>2</sub> before and after AVF creation. This study aimed to monitor the differences in cerebral oxygenation before and after AVF creation and to clarify the clinical factors affecting the changes in cerebral rSO<sub>2</sub>.</p><p><strong>Methods: </strong>Forty-eight patients (34 men, 14 women) with chronic kidney disease (CKD) who were not undergoing dialysis and newly created AVF were recruited. Cerebral rSO<sub>2</sub> values before and after AVF creation were evaluated using near-infrared spectroscopy (INVOS 5100c).</p><p><strong>Results: </strong>Cerebral rSO<sub>2</sub> values were significantly changed from 60.3% ± 7.5% to 58.4% ± 6.8% before and after AVF creation in all patients (<i>p</i> < 0.001). Cerebral rSO<sub>2</sub> were also lower in patients with diabetes mellitus (DM) than in those without DM (57.5 ± 7.1 vs 63.7 ± 6.5, <i>p</i> = 0.003) before surgery; however, no differences of changes in cerebral rSO<sub>2</sub> were observed between the two groups after AVF creation. Additionally, multivariate regression analysis identified changes in HR (standardized coefficient: 0.436) as independent factors associated with changes in cerebral rSO<sub>2</sub>.</p><p><strong>Conclusion: </strong>Surgically created AVF was associated with the deterioration of cerebral rSO<sub>2</sub> in patients with CKD not undergoing dialysis. Notably, AVF could cause cerebral hypoxia, and thus further studies are needed to clarify the clinical factors influencing changes in cerebral oxygenation after AVF creation.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"945-951"},"PeriodicalIF":1.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects to cerebral oxygenation by arteriovenous fistula creation in patients with chronic kidney disease.\",\"authors\":\"Yuko Mutsuyoshi, Kiyonori Ito, Susumu Ookawara, Yuichiro Ueda, Mitsutoshi Shindo, Momoko Hirata, Hiroaki Nonaka, Junki Morino, Shohei Kaneko, Taisuke Kitano, Haruhisa Miyazawa, Keiji Hirai, Yoshiyuki Morishita\",\"doi\":\"10.1177/11297298241257431\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Vascular access, including arteriovenous fistula (AVF), is essential in patients undergoing hemodialysis (HD). However, the presence of AVF is non-physiological in humans and could pose a burden to the systemic circulation or tissue microcirculation, potentially affecting tissue oxygenation, including in the brain. Recently, near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO<sub>2</sub>) as a marker of cerebral oxygenation in various settings, including in patients undergoing HD. Thus far, no studies have reported changes in cerebral rSO<sub>2</sub> before and after AVF creation. This study aimed to monitor the differences in cerebral oxygenation before and after AVF creation and to clarify the clinical factors affecting the changes in cerebral rSO<sub>2</sub>.</p><p><strong>Methods: </strong>Forty-eight patients (34 men, 14 women) with chronic kidney disease (CKD) who were not undergoing dialysis and newly created AVF were recruited. Cerebral rSO<sub>2</sub> values before and after AVF creation were evaluated using near-infrared spectroscopy (INVOS 5100c).</p><p><strong>Results: </strong>Cerebral rSO<sub>2</sub> values were significantly changed from 60.3% ± 7.5% to 58.4% ± 6.8% before and after AVF creation in all patients (<i>p</i> < 0.001). Cerebral rSO<sub>2</sub> were also lower in patients with diabetes mellitus (DM) than in those without DM (57.5 ± 7.1 vs 63.7 ± 6.5, <i>p</i> = 0.003) before surgery; however, no differences of changes in cerebral rSO<sub>2</sub> were observed between the two groups after AVF creation. Additionally, multivariate regression analysis identified changes in HR (standardized coefficient: 0.436) as independent factors associated with changes in cerebral rSO<sub>2</sub>.</p><p><strong>Conclusion: </strong>Surgically created AVF was associated with the deterioration of cerebral rSO<sub>2</sub> in patients with CKD not undergoing dialysis. Notably, AVF could cause cerebral hypoxia, and thus further studies are needed to clarify the clinical factors influencing changes in cerebral oxygenation after AVF creation.</p>\",\"PeriodicalId\":56113,\"journal\":{\"name\":\"Journal of Vascular Access\",\"volume\":\" \",\"pages\":\"945-951\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Vascular Access\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/11297298241257431\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/2 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular Access","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/11297298241257431","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/2 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Effects to cerebral oxygenation by arteriovenous fistula creation in patients with chronic kidney disease.
Background: Vascular access, including arteriovenous fistula (AVF), is essential in patients undergoing hemodialysis (HD). However, the presence of AVF is non-physiological in humans and could pose a burden to the systemic circulation or tissue microcirculation, potentially affecting tissue oxygenation, including in the brain. Recently, near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO2) as a marker of cerebral oxygenation in various settings, including in patients undergoing HD. Thus far, no studies have reported changes in cerebral rSO2 before and after AVF creation. This study aimed to monitor the differences in cerebral oxygenation before and after AVF creation and to clarify the clinical factors affecting the changes in cerebral rSO2.
Methods: Forty-eight patients (34 men, 14 women) with chronic kidney disease (CKD) who were not undergoing dialysis and newly created AVF were recruited. Cerebral rSO2 values before and after AVF creation were evaluated using near-infrared spectroscopy (INVOS 5100c).
Results: Cerebral rSO2 values were significantly changed from 60.3% ± 7.5% to 58.4% ± 6.8% before and after AVF creation in all patients (p < 0.001). Cerebral rSO2 were also lower in patients with diabetes mellitus (DM) than in those without DM (57.5 ± 7.1 vs 63.7 ± 6.5, p = 0.003) before surgery; however, no differences of changes in cerebral rSO2 were observed between the two groups after AVF creation. Additionally, multivariate regression analysis identified changes in HR (standardized coefficient: 0.436) as independent factors associated with changes in cerebral rSO2.
Conclusion: Surgically created AVF was associated with the deterioration of cerebral rSO2 in patients with CKD not undergoing dialysis. Notably, AVF could cause cerebral hypoxia, and thus further studies are needed to clarify the clinical factors influencing changes in cerebral oxygenation after AVF creation.
期刊介绍：
The Journal of Vascular Access (JVA) is issued six times per year; it considers the publication of original manuscripts dealing with clinical and laboratory investigations in the fast growing field of vascular access. In addition reviews, case reports and clinical trials are welcome, as well as papers dedicated to more practical aspects covering new devices and techniques.
All contributions, coming from all over the world, undergo the peer-review process.
The Journal of Vascular Access is divided into independent sections, each led by Editors of the highest scientific level:
• Dialysis
• Oncology
• Interventional radiology
• Nutrition
• Nursing
• Intensive care
Correspondence related to published papers is also welcome.
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