Deterioration of Hepatic Oxygenation Precedes an Onset of Intradialytic Hypotension with Little Change in Blood Volume during Hemodialysis

Imai, Sojiro; Ookawara, Susumu; K, Ito; Kiryu, Satoshi; Tabei, Kaoru; Morishita, Yoshiyuki

doi:10.1159/000486232

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…Such a maldistribution of blood flow could explain why in our experiments renal filtration appears to become less efficient during HD. While in the heart this would result into cardiac and hemodynamic failure and arrhythmia, in the brain and liver ischemic injury would lead to cognitive impairment 77 and a reduced toxin clearance 78 , respectively. Furthermore, it was found that a hemodialysis procedure affects the renal functionality, ultimately resulting in a decline in residual renal function 79 .…”

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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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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“…8 In addition, hepatic rSO 2 is stable during HD, 9 whereas it decreases at the onset of IDH. 10,11 According to previous reports, the burden of the HD procedure, including ultrafiltration and changes in systemic BP, could lead to a reduction of the blood volume in the hepato-splanchnic circulation during HD; therefore, a decrease in intradialytic hepatic oxygenation would be expected in response to these influences. However, few clinical studies have investigated the association between changes in intradialytic hepatic rSO 2 and clinical factors such as ultrafiltration, changes in systemic BP, and the onset of IDH.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting intradialytic hepatic oxygenation: Associations between ultrafiltration rate and changes in systemic blood pressure

Ookawara

Ueda

et al. 2023

Int J Artif Organs

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Introduction: Hepato-splanchnic circulation influences the oxygenation of abdominal organs and is important in preventing a reduction in intradialytic blood volume. However, the association between changes in intradialytic hepato-splanchnic circulation and clinical factors remain unknown. Methods: We enrolled 91 hemodialysis (HD) patients (20 with intradialytic hypotension (IDH) and 71 without IDH). During HD, hepatic regional oxygen saturation (rSO2), a marker of hepatic oxygenation reflecting hepato-splanchnic circulation and oxygenation, was monitored. Changes in hepatic rSO2 at the lowest systolic blood pressure (BP) during HD were analyzed to identify associations with clinical factors. Results: Hepatic rSO2 levels were 55.8 ± 15.3% before HD and 53.8 ± 14.9% at the lowest systolic BP; therefore, % changes in hepatic rSO2 were −2.7 ± 11.3%. These values were significantly lower in patients with IDH than in those without IDH (−13.8 ± 9.3% vs 0.4 ± 9.8%, p < 0.001). Multivariable regression analysis showed that % changes in hepatic rSO2 were independently associated with % changes in systolic BP (standardized coefficient: 0.416) and ultrafiltration rate (−0.206). Furthermore, % changes in mean BP (0.304) were identified as affecting % changes in hepatic rSO2 instead of those in systolic BP. Conclusions: Changes in intradialytic hepatic oxygenation is associated with ultrafiltration rate and changes in systemic BP. Further studies are required to clarify the directionality of the association between changes in hepatic oxygenation and changes in systemic BP during HD.

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“…Hepatic rSO 2 values, which were recently used to evaluate the hepato-splanchnic circulation and oxygenation of patients undergoing HD, were reportedly maintained during HD without intradialytic hypotension [ 9 ], and significantly increased in response to an increase in hemoglobin (Hb) level by intradialytic blood transfusion [ 10 ]. Additionally, a decrease in hepatic rSO 2 was confirmed prior to intradialytic hypotension during HD [ 11 , 12 ]. However, few reports have examined the association between hepatic rSO 2 before HD and clinical factors in patients undergoing HD, and the clinical factors that affect hepatic rSO 2 remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Association between hepatic oxygenation on near-infrared spectroscopy and clinical factors in patients undergoing hemodialysis

Ueda

Ookawara

et al. 2021

PLoS ONE

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The hepato-splanchnic circulation directly influences oxygenation of the abdominal organs and plays an important role in compensating for the blood volume reduction that occurs in the central circulation during hemodialysis (HD) with ultrafiltration. However, the hepato-splanchnic circulation and oxygenation cannot be easily evaluated in the clinical setting of HD therapy. We included 185 HD patients and 15 healthy volunteers as the control group in this study. Before HD, hepatic regional oxygen saturation (rSO2), a marker of hepatic oxygenation reflecting the hepato-splanchnic circulation and oxygenation, was monitored using an INVOS 5100c oxygen saturation monitor. Hepatic rSO2 was significantly lower in patients undergoing HD than in healthy controls (56.4 ± 14.9% vs. 76.2 ± 9.6%, p < 0.001). Multivariable regression analysis showed that hepatic rSO2 was independently associated with body mass index (BMI; standardized coefficient: 0.294), hemoglobin (Hb) level (standardized coefficient: 0.294), a history of cardiovascular disease (standardized coefficient: -0.157), mean blood pressure (BP; standardized coefficient: 0.154), and serum albumin concentration (standardized coefficient: 0.150) in Model 1 via a simple linear regression analysis. In Model 2 using the colloid osmotic pressure (COP) in place of serum albumin concentration, the COP (standardized coefficient: 0.134) was also identified as affecting hepatic rSO2. Basal hepatic oxygenation before HD might be affected by BMI, Hb levels, a history of cardiovascular disease, mean BP, serum albumin concentration, and the COP. Further prospective studies are needed to clarify whether changes in these parameters, including during HD, affect the hepato-splanchnic circulation and oxygenation in HD patients.

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Deterioration of Hepatic Oxygenation Precedes an Onset of Intradialytic Hypotension with Little Change in Blood Volume during Hemodialysis

Cited by 7 publications

References 10 publications

Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats

Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats

Factors affecting intradialytic hepatic oxygenation: Associations between ultrafiltration rate and changes in systemic blood pressure

Association between hepatic oxygenation on near-infrared spectroscopy and clinical factors in patients undergoing hemodialysis

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