Cerebral blood flow decreases during intermittent hemodialysis in patients with acute kidney injury, but not in patients with end-stage renal disease

Regolisti, Giuseppe; Maggiore, Umberto; Cademartiri, Carola; Cabassi, Aderville; Caiazza, A.; Tedeschi, Stefano; Antonucci, Elio; Fiaccadori, Enrico

doi:10.1093/ndt/gfs182

Cited by 26 publications

(24 citation statements)

References 42 publications

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“…In contrast to our present study, in which all the ESRD patients were undergoing hemodialysis, only 33 of 57 ESRD patients were on hemodialysis in their study [24]. Studies based on transcranial Doppler have indicated a decrease in the mean flow velocity (mfv) at the level of the middle cerebral artery (MCA) during hemodialysis, MCAmfv has been proposed as a reliable proxy for cerebral blood flow [33]–[35]. In addiction, lower cerebral blood flow has always been associated with lower brain gray matter volume and lower cortical thickness [36]–[38].…”

Section: Discussioncontrasting

confidence: 67%

Structural and Functional Brain Alterations in End Stage Renal Disease Patients on Routine Hemodialysis: A Voxel-Based Morphometry and Resting State Functional Connectivity Study

Qiu

et al. 2014

PLoS ONE

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Background and PurposeCognitive impairment is a well-described phenomenon in end-stage renal disease (ESRD) patients. However, its pathogenesis remains poorly understood. The primary focus of this study was to examine structural and functional brain deficits in ESRD patients.Materials and MethodsThirty ESRD patients on hemodialysis (without clinical neurological disease) and 30 age- and gender-matched control individuals (without renal or neurological problems) were recruited in a prospective, single-center study. High-resolution structural magnetic resonance imaging (MRI) and resting state functional MRI were performed on both groups to detect the subtle cerebral deficits in ESRD patients. Voxel-based morphometry was used to characterize gray matter deficits in ESRD patients. The impact of abnormal morphometry on the cerebral functional integrity was investigated by evaluating the alterations in resting state functional connectivity when brain regions with gray matter volume reduction were used as seed areas.ResultsA significant decrease in gray matter volume was observed in ESRD patients in the bilateral medial orbito-prefrontal cortices, bilateral dorsal lateral prefrontal cortices, and the left middle temporal cortex. When brain regions with gray matter volume reduction were used as seed areas, the integration was found to be significantly decreased in ESRD patients in the fronto-cerebellum circuits and within prefrontal circuits. In addition, significantly enhanced functional connectivity was found between the prefrontal cortex and the left temporal cortex and within the prefrontal circuits.ConclusionsOur study revealed that both the structural and functional cerebral cortices were impaired in ESRD patients on routine hemodialysis.

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Section: Discussioncontrasting

confidence: 67%

Structural and Functional Brain Alterations in End Stage Renal Disease Patients on Routine Hemodialysis: A Voxel-Based Morphometry and Resting State Functional Connectivity Study

Qiu

et al. 2014

PLoS ONE

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“…Previous studies have shown that long-term hemodialysis could lead to cerebral abnormalities of oxygenation [10] and cerebral blood flow in ESRD [44–46], which could significantly affect the brain function and cerebral circulation [47–50]. Recent studies have highlighted important roles of cerebral blood flow and metabolism in establishing and retaining interregional functional coordination in the brain [51,52].…”

Section: Discussionmentioning

confidence: 99%

Spatial Disassociation of Disrupted Functional Connectivity for the Default Mode Network in Patients with End-Stage Renal Disease

Jian-guo

et al. 2016

PLoS ONE

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PurposeTo investigate the aberrant functional connectivity of the default mode network (DMN) in patients with end-stage renal disease (ESRD) and their clinical relevance.Materials and MethodsResting-state functional MRI data were collected from 31 patients with ESRD (24 men, 24–61 years) and 31 age- and gender-matched healthy controls (HCs, 21 men, 26-61years). A whole-brain seed-based functional connectivity analysis of these collected R-fMRI data was performed by locating the seeds in the posterior cingulate cortex (PCC) and ventromedial prefrontal cortex (vmPFC) to investigate the functional connectivity of the posterior and anterior DMN over the whole brain, respectively.ResultsCompared to the HCs, the patients exhibited significantly decreased functional connectivity with the PCC in the left middle temporal gyrus, the right anterior cingulate gyrus, and the bilateral medial superior frontal gyrus. For the vmPFC seed, only the right thalamus showed significantly decreased functional connectivity in the patients with ESRD compared to HCs. Interestingly, functional connectivity between the PCC and right medial superior frontal gyrus exhibited a significantly positive correlation with the hemoglobin level in the patients.ConclusionOur findings suggest a spatially specific disruption of functional connectivity in the DMN in patients with ESRD, thereby providing novel insights into our understanding of the neurophysiology mechanism that underlies the disease.

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“…HD is performed to remove accumulated substances, improve electrolyte disturbances, and control body-fluid disturbances. However, whether HD provides a beneficial effect on cerebral tissue remains unclear, and changes in cerebral blood flow during HD also remain controversial [6,7,8,9]. Few reports have examined the relationship between cerebral oxygenation and blood volume (BV) reduction induced by ultrafiltration during HD.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Cerebral Oxygenation in Patients Undergoing Long-Term Hemodialysis

et al. 2014

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Background/Aims: Patients undergoing hemodialysis (HD) have higher occurrence rates of cerebral diseases, including uremic encephalopathy, cognitive impairment, dementia, and cerebrovascular disease, than the general population. During HD, ultrafiltration is performed to maintain an adequate fluid condition and is associated with subsequent blood volume (BV) reduction. We aimed to (1) monitor changes in cerebral oxygenation and BV reduction during HD, and (2) clarify the mechanism that influences cerebral oxygenation in HD patients. Methods: Eighteen HD patients and 12 healthy controls were recruited. Regional saturation of oxygen (rSO₂) was continuously monitored in the frontal cortex using INVOS 5100C before, during, and after HD, and in healthy controls. Relative change in BV (%ΔBV) was simultaneously monitored during HD using a BV monitor. Results: Before HD, patients had significantly lower rSO₂ values than controls (56.1 ± 1.4 vs. 70.4 ± 2.5%, p < 0.001). Although %ΔBV significantly decreased from 20 min to the end of HD (20 min: -3.3 ± 0.3%, p < 0.05; end of HD: -12.0 ± 1.0%, p < 0.01), changes in rSO₂ values during HD were not significant. No relationship existed between rSO₂ values and blood pressure levels, hemoglobin levels, oxygen pressure, HCO₃^-, oxygen saturation, and arterial O₂ content before and after HD. Furthermore, changes in rSO₂ were not correlated with changes in these parameters. Conclusion: rSO₂ values before HD were significantly lower in HD patients than in healthy controls. rSO₂ values were maintained during HD and were not influenced by BV reduction.

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Cerebral blood flow decreases during intermittent hemodialysis in patients with acute kidney injury, but not in patients with end-stage renal disease

Cited by 26 publications

References 42 publications

Structural and Functional Brain Alterations in End Stage Renal Disease Patients on Routine Hemodialysis: A Voxel-Based Morphometry and Resting State Functional Connectivity Study

Structural and Functional Brain Alterations in End Stage Renal Disease Patients on Routine Hemodialysis: A Voxel-Based Morphometry and Resting State Functional Connectivity Study

Spatial Disassociation of Disrupted Functional Connectivity for the Default Mode Network in Patients with End-Stage Renal Disease

Evaluation of Cerebral Oxygenation in Patients Undergoing Long-Term Hemodialysis

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