Deterioration of Cerebral Oxygenation by Aortic Arch Calcification Progression in Patients Undergoing Hemodialysis: A Cross-Sectional Study

Abstract

Background Near-infrared spectroscopy revealed that the regional saturation of oxygen (rSO2) in cerebral tissue is lower in hemodialysis (HD) patients than in healthy subjects. However, no study has examined the changes in cerebral oxygenation by aortic arch calcification (AAC) progression in HD patients. Methods A total of 104 HD patients were divided into four groups by AAC grade determined using chest radiography: 23 patients at grade 0, 24 at grade 1, 30 at grade 2, and 27 at grade 3. Differences in clinical parameters, including cerebral rSO2, among AAC grades were investigated and atherosclerotic parameters affecting cerebral rSO2 values were identified. Results Cerebral rSO2 significantly decreased as AAC progressed (AAC grade 3 versus grade 0, p < 0.01 versus grade 1, p < 0.05). Multivariate logistic regression analysis was performed using parameters with p values < 0.20 in univariate analysis between cerebral rSO2 values less than the mean and atherosclerotic parameters. AAC grades 2 and 3, serum phosphate level, and history of smoking were factors associated with the cerebral rSO2 decrease. Conclusions Cerebral rSO2 significantly decreased as AAC progressed and was independently associated with higher AAC grade, serum phosphate level, and history of smoking.

Association of cerebral oxygenation with estimated glomerular filtration rate and cognitive function in chronic kidney disease patients without dialysis therapy

“…Concerning the vascular injury in CKD patients, the onset of CKD, which even occurred in early stages, stimulated aortic calcification in rat CKD models with mild or moderate renal injury [ 26 ], and aortic arch calcification was not only a consequence of CKD but also a predictor of renal function progression in CKD G3 to G5 patients [ 27 ]. Furthermore, recently in HD patients, cerebral rSO 2 significantly decreased according to the progression of aortic arch calcification because of a decreased oxygen supply in the brain via cerebral macro- and/or microcirculation impairments [ 28 ]. Thus, even in the CKD patients enrolled in this study, cerebral rSO 2 deterioration might have occurred due to cerebral vascular injury, including calcification associated with CKD progression itself, although we could not comment on the association between cerebral oxygenation and vascular injury with CKD patients because no examination was conducted to investigate vascular injury or calcification in this study.…”

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

“…The measurement of cerebral rSO 2 by NIRS has recently been performed in various clinical settings, including cardiovascular surgery, pediatrics, and dialysis [3][4][5][6][7][8][16][17][18]. We therefore, reviewed the literature for reports of cerebral rSO 2 values in dialysis patients (Table 1).…”

“…Near-infrared spectroscopy (NIRS) has recently been used to measure regional saturation of oxygen (rSO 2 ), as a marker of tissue oxygenation. In particular, cerebral rSO 2 was measured in patients in various clinical settings, including hemodialysis (HD) patients [3][4][5][6][7][8]. It would be considered important to maintain cerebral rSO 2 levels because that low cerebral rSO 2 has been associated with cognitive impairment in patients with chronic kidney disease (CKD) [5,8] and poor neurologic outcomes in post-cardiac arrest patients [7].…”

Assessment of Endothelial and Microvascular Function in CKD: Older and Newer Techniques, Associated Risk Factors, and Relations with Outcomes

“…In a retrospective study including 49 patients (9 hemodialysis and 40 nonhemodialysis) that underwent coronary artery bypass graft surgery, hemodialysis patients had lower rSO 2 levels, even after adjusting for age, hemoglobin, and LV ejection fraction [97]. A cross-sectional study including 104 hemodialysis patients indicated that cerebral rSO 2 significantly decreased as aortic-arch calcification progressed and was independently associated with serum phosphate and history of smoking [98]. Finally, studies evaluating cerebral oxygenation during dialysis session have shown that cerebral oxygenation deteriorates after the beginning of hemodialysis [93, 99]; cerebral ischemia cannot be predicted from BP alterations during dialysis, and this leads to high risk of stroke and cognitive dysfunction development [100, 101].…”