Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis

Abstract

Background: Hemodialysis (HD) patients frequently suffer from severe anemia caused by various hemorrhagic disorders in addition to renal anemia. Intradialytic blood transfusion is sometimes performed; however, the cerebral oxygenation changes associated with this procedure remain unclear. Methods: Sixteen HD patients with severe anemia who required intradialytic blood transfusion were included (12 men and 4 women; mean age, 64.8 ± 9.8 years). Cerebral regional oxygen saturation (rSO₂) was monitored using near-infrared spectroscopy, and cerebral fractional oxygen extraction (FOE) was calculated before and after HD. Twenty-five HD patients with well-maintained hemoglobin (Hb) levels were included as a control group. Results: Cerebral rSO₂ values were significantly lower in HD patients with severe anemia than in the control group (42.4 ± 9.9 vs. 52.5 ± 8.5%, p = 0.001). Following intradialytic blood transfusion (385 ± 140 mL of concentrated red blood cells), Hb levels significantly increased (from 7.2 ± 0.9 to 9.1 ± 1.1 g/dL, p < 0.001), and cerebral rSO₂ values significantly improved after HD (from 42.4 ± 9.9 to 46.3 ± 9.0%, p < 0.001). Cerebral FOE values before HD in patients with severe anemia were significantly higher than those in the control group (severe anemia, 0.56 ± 0.10; controls, 0.45 ± 0.08; p < 0.001). After HD with intradialytic blood transfusion, these values significantly decreased (0.52 ± 0.09 after HD versus 0.56 ± 0.10 before HD, p = 0.002). Conclusion: HD patients with severe anemia represented cerebral oxygen metabolism deterioration, which could be significantly improved by intradialytic blood transfusion.

Cerebral ischemia during hemodialysis—finding the signal in the noise

“…There are few studies investigating cerebral NIRS during hemodialysis; most have looked at very small numbers of sessions with no evaluation of neurological outcomes . However, our own group has found an association between decline in executive cognitive function over 12 months and typical exposure to intra‐dialytic cerebral ischemia, defined by area under the curve below the cut‐off of a relative 15% drop in NIRS‐measured cerebral saturations .…”

Sleep apnea syndrome caused lowering of cerebral oxygenation in a hemodialysis patient: a case report and literature review

“…Furthermore, in the clinical setting of HD therapy, cognitive impairment is common in patients undergoing HD and the pathogenesis of cognitive impairment would be associated with hemodynamic factors including changes in BP or anemia [11]. In particular, both intradialytic hypotension and anemia reportedly induced the deterioration of cerebral oxygenation [12,13]. In addition, the decrease in cerebral oxygen supply was associated with neuronal death, and hypoxia promoted the formation of amyloid ß peptide in experimental studies [14,15].…”

“…Furthermore, longer HD therapy itself might cause hypoxia of the brain because HD duration was negatively associated with cerebral rSO 2 [3,19]. Regarding the association between cerebral rSO 2 and clinical parameters in maintenance HD patients, various factors, i.e., serum albumin, pH, Hb, and blood pressure, were related to cerebral rSO 2 [3,13,23]. Based on these previous reports, it would be important to maintain the nutritional status, and control Hb level and blood pressure in the clinical setting of HD therapy.…”

What lies downstream: Cellular oxygen delivery during hemodialysis

“…The NIRS lends itself to continuous, noninvasive monitoring of intradialytic frontal lobe saturations . Malik monitored cerebral NIRS during 17 hemodialysis sessions, and found an overall fall in regional saturations .…”

“…The NIRS lends itself to continuous, noninvasive monitoring of intradialytic frontal lobe saturations. 3,[38][39][40] Malik monitored cerebral NIRS during 17 hemodialysis sessions, and found an overall fall in regional saturations. 41 Conversely, a group in Japan published two small studies in hemodynamically stable patients showing that cerebral oxygenation remained unchanged throughout hemodialysis.…”