Detection of microcirculatory impairment by transcutaneous oxymetry monitoring during hemodialysis: an observational study

Benhamou, Y.; Begarin, Loic; David, Nadine; Cailleux, N.; Bessin, Catherine; Lévesque, H.; Edet, Stéphane

doi:10.1186/1471-2369-15-4

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…have observed severe ischemia (defined as a transcutaneous (TcpO 2 ) levels <30 mmHg, and critical ischemia (TcpO 2 <10 mmHg) during HD in 47% and 16% of patients, respectively (81). Critical ischemia was only observed in those patients with peripheral vascular disease, showing the importance of the deleterious interaction between preexisting abnormalities in the vascular tree and the effect of HD.…”

Section: Systemic Consequences Of Hypoxia At Tissue Levelmentioning

confidence: 99%

The oxygen cascade in patients treated with hemodialysis and native high-altitude dwellers: lessons from extreme physiology to benefit patients with end-stage renal disease

Kooman

Stenvinkel

Shiels

et al. 2021

American Journal of Physiology-Renal Physiology

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Hemodialysis patients repeatedly undergo intradialytic low arterial oxygen saturation, as well as low central venous oxygen saturation, reflecting an imbalance between upper body systemic oxygen supply and demand, which are associated with increased mortality. Abnormalities along the entire oxygen cascade, with impaired diffusive and convective oxygen transport, contribute to the reduced tissue oxygen supply. Dialysis treatment impairs pulmonary gas exchange and reduces ventilatory drive, whereas ultrafiltration can reduce tissue perfusion due to a decline in cardiac output. In addition to these factors, capillary rarefaction and reduced mitochondrial efficacy can further affect the balance between cellular oxygen supply and demand. Whereas it has been convincingly demonstrated that a reduced perfusion of heart and brain during dialysis contributes to organ damage, the significance of systemic hypoxia remains uncertain, although it may contribute to oxidative stress, systemic inflammation and accelerated senescence. These abnormalities along the oxygen cascade of dialysis patients appear to be diametrically opposite to the situation in Tibetan highlanders and Sherpa, whose physiology adapted to the inescapable hypobaric hypoxia of their living environment over many generations. Their adaptation includes pulmonary, vascular and metabolic alterations with enhanced capillary density, nitric oxide production and mitochondrial efficacy without oxidative stress. Improving the tissue oxygen supply in dialysis patients depends primarily on preventing hemodynamic instability by increasing dialysis time/frequency or prescribing cool dialysis. Whether dietary or pharmacological interventions, such as the administration of L-arginine, fermented food, nitrate, Nrf2 agonists or prolyl hydroxylase 2 inhibitors improve clinical outcome in dialysis patients warrants future research.

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Section: Systemic Consequences Of Hypoxia At Tissue Levelmentioning

confidence: 99%

The oxygen cascade in patients treated with hemodialysis and native high-altitude dwellers: lessons from extreme physiology to benefit patients with end-stage renal disease

Kooman

Stenvinkel

Shiels

et al. 2021

American Journal of Physiology-Renal Physiology

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“…Overall, TcpO 2 declined from 45.7 ± 15.5 vs. 33.5 ± 15.6 mm Hg. This tissue again shows that significant changes in tissue perfusion may accompany routine HD treatments [40]. …”

Section: Changes In Perfusion Are Important But How Can They Be Measmentioning

confidence: 99%

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

et al. 2018

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Background: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. Summary: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia. Recent studies have stressed the relevance of changes in tissue perfusion during HD, which may translate in long-term organ damage. Monitoring changes in tissue perfusion, for which emerging evidence becomes available, appears to have great promise in the fine-tuning of the dialysis procedure. Key Messages: While it is unlikely that IDH can be completely prevented, reduction in inter-dialytic weight gain, prevention of an increase in core temperature by adjusting the dialysate temperature and more frequent or prolonged dialysis treatment remain cornerstones in providing a more comfortable and safe treatment.

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“…Other investigations have shown that tissue perfusion can be affected by HD, and subclinical perfusion disturbances due to hemodialysis have been reported throughout the entire body 24 , 54 , 55 . HD has been shown to induce cardiac stunning in patients due to the maldistribution of myocardial blood flow, which ultimately cause irreversible structural change of the myocardium 25 .…”

Section: Discussionmentioning

confidence: 99%

Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats

Janssen

Zhang

Kosik

et al. 2022

Sci Rep

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Hemodialysis (HD) provides life-saving treatment for kidney failure. Patient mortality is extremely high, with cardiovascular disease (CVD) being the leading cause of death. This results from both a high underlying burden of cardiovascular disease, as well as additional physiological stress from the HD procedure itself. Clinical observations indicate that HD is associated with microvascular dysfunction (MD), underlining the need for a fundamental pathophysiological assessment of the microcirculatory consequences of HD. We therefore successfully developed an experimental small animal model, that allows for a simultaneous real-time assessment of the microvasculature. Using in-house built ultra-low surface area dialyzers and miniaturized extracorporeal circuit, we successfully dialyzed male Wistar Kyoto rats and combined this with a simultaneous intravital microscopic observation of the EDL microvasculature. Our results show that even in healthy animals, a euvolemic HD procedure can induce a significant systemic hemodynamic disturbance and induce disruption of microvascular perfusion (as evidence by a reduction in the proportion of the observed microcirculation receiving blood flow). This study, using a new small animal hemodialysis model, has allowed direct demonstration that microvascular blood flow in tissue in skeletal muscle is acutely reduced during HD, potentially in concert with other microvascular beds. It shows that preclinical small animal models can be used to further investigate HD-induced ischemic organ injury and allow rapid throughput of putative interventions directed at reducing HD-induced multi-organ ischemic injury.

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Detection of microcirculatory impairment by transcutaneous oxymetry monitoring during hemodialysis: an observational study

Cited by 9 publications

References 30 publications

The oxygen cascade in patients treated with hemodialysis and native high-altitude dwellers: lessons from extreme physiology to benefit patients with end-stage renal disease

The oxygen cascade in patients treated with hemodialysis and native high-altitude dwellers: lessons from extreme physiology to benefit patients with end-stage renal disease

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats

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