Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation

Abstract

Introduction: Near-infrared spectroscopy has been used to measure the regional oxygen saturation (rSO2) of the brain, and decreases in cerebral rSO2 have been reported to lead to cognitive impairment in patients undergoing hemodialysis. However, reports about the association between changes in cerebral oxygenation and clinical parameters at hemodialysis initiation, including hemoglobin level, are lacking. Methods: This study included 33 patients at the hemodialysis initiation phase. Cerebral rSO2 was monitored using an INVOS 5100C. Included patients were assessed twice (at hemodialysis initiation and 42.7 ± 20.8 days after the first measurement), and changes in cerebral rSO2 were compared with changes in clinical parameters. Results: Cerebral rSO2 at the second measurement significantly increased compared with that at hemodialysis initiation (57.2 ± 6.8% vs 54.4 ± 8.8%, p < 0.05). Changes in cerebral rSO2 represented a significant correlation with changes in hemoglobin level, pulse rate, and serum albumin level. Multivariate linear regression analysis was performed using significant factors in simple linear regression analysis. Changes in hemoglobin (standardized coefficient: 0.37) and serum albumin (standardized coefficient: 0.45) levels were identified as independent factors influencing the changes in cerebral rSO2. Conclusion: Cerebral rSO2 was low in the presence of low hemoglobin levels at hemodialysis initiation and improved in response to hemoglobin increase in addition to changes in serum albumin levels. Attention should be paid to changes in hemoglobin levels even at hemodialysis initiation to prevent the deterioration of cerebral oxygenation, and this might contribute to the maintenance of cognitive function in patients undergoing hemodialysis.

Cognitive Impairment in End Stage Renal Disease Patients Undergoing Hemodialysis: Markers and Risk Factors

“…The first found that HD patients with cognitive impairment had lower rSO 2 levels in the brain than patients with normal cognitive functions [67]. The second study found that changes in rSO 2 levels in the brain are significantly related to hemoglobin levels, pulse rate, and serum albumin levels [68].…”

Pre- and Post-Hemodialysis Cerebral Blood Flow Velocity in Patients With End-Stage Renal Disease

“…Results of near-infrared spectroscopy studies, which evaluate the regional oxygen saturation (rSO2) of the brain revealed contradictory results. Ito et al 20 demonstrated an increase in follow-up cerebral rSO2 values compared with the values at the beginning of HD, which may be due to an improvement in hemoglobin levels after dialysis. Another cohort of 15 pediatric patients receiving chronic HD identified no significant difference between pre and post-HD values of cerebral rSO2 21 .…”

Effects of percutaneous transluminal angioplasty and associated factors in access hand oxygenation in patients undergoing hemodialysis

“…Low tissue oxygenation may have negative influence on HD patients. Anemic conditions, overhydrated status, and hypotension could induce organ hypoxia in the brain or intra-abdominal organs [20][21][22][26][27][28] . Furthermore, cerebral oxygenation impairment could be related to cognitive impairment 29,30 , and access hand rSO 2 was reportedly associated with grip strength 31 .…”

“…Thereafter, each rSO 2 measurement was performed at rest in the supine position in the bed for at least 5 min, and mean values were defined as the measured rSO 2 values. The attachment parts of the sensor and monitoring time of rSO 2 were determined based on previous reports 10 , 12 , 19 , 27 . Measured rSO 2 values were shown as results before and after PTA.…”