Online monitoring of cerebral hemodynamics during hemodialysis

Metry, George; Spittle, Margaret; Rahmati, Shahriar; Giller, Cole A.; Giller, Angela M.; Kaufman, Allen; Schneditz, Daniel; Brener, Zohar; Boniece, Irene; Ronco, Federico; Ronco, Claudio; Levin, Nathan W.

doi:10.1053/ajkd.2002.36333

Cited by 31 publications

(26 citation statements)

References 21 publications

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“…Other investigators have reported similar findings (33,34), with blood flow reductions noted in the middle cerebral artery and the basilar artery after HD (35). However, some studies report contrary findings, suggesting that cerebral blood flow does not change significantly during or after HD (36). Many functional neuroimaging studies also have used SPECT in their examination of blood flow velocities images) The prevalence of SCI was significantly higher in HD patients than in healthy controls (P,0.0001).…”

Section: Findings In Adult Functional Neuroimaging Studiesmentioning

confidence: 66%

Systematic Review of Structural and Functional Neuroimaging Findings in Children and Adults with CKD

Moodalbail

Reiser

Detre³

et al. 2013

Clinical Journal of the American Society of Nephrology

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Summary CKD has been linked with cognitive deficits and affective disorders in multiple studies. Analysis of structural and functional neuroimaging in adults and children with kidney disease may provide additional important insights into the pathobiology of this relationship. This paper comprehensively reviews neuroimaging studies in both children and adults. Major databases (PsychLit, MEDLINE, WorldCat, ArticleFirst, PubMed, Ovid MEDLINE) were searched using consistent search terms, and studies published between 1975 and 2012 were included if their samples focused on CKD as the primary disease process. Exclusion criteria included case reports, chapters, and review articles. This systematic process yielded 43 studies for inclusion (30 in adults, 13 in children). Findings from this review identified several clear trends: (1) presence of cerebral atrophy and cerebral density changes in patients with CKD; (2) cerebral vascular disease, including deep white matter hyperintensities, white matter lesions, cerebral microbleeds, silent cerebral infarction, and cortical infarction, in patients with CKD; and (3) similarities in regional cerebral blood flow between patients with CKD and those with affective disorders. These findings document the importance of neuroimaging procedures in understanding the effect of CKD on brain structure, function, and associated behaviors. Results provide a developmental linkage between childhood and adulthood, with respect to the effect of CKD on brain functioning across the lifespan, with strong implications for a cerebrovascular mechanism contributing to this developmental linkage. Use of neuroimaging methods to corroborate manifest neuropsychological deficits or perhaps to indicate preventive actions may prove useful to individuals with CKD.

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Section: Findings In Adult Functional Neuroimaging Studiesmentioning

confidence: 66%

Systematic Review of Structural and Functional Neuroimaging Findings in Children and Adults with CKD

Moodalbail

Reiser

Detre³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Longer capillary and venous blood transit times correspond to a reduced cerebral blood flow velocity in the microcirculation. Reduced blood flow velocity in the middle cerebral artery has been repeatedly measured by transcranial Doppler ultrasound during hemodialysis, 24,26,32,45,46 and it has been tentatively associated with increased blood viscosity 26,33 or oxygen carrying capacity alterations. 26,33 Our findings on the hemodialysis patients, all measured within the first hour of the hemodialysis procedure, indicate a reduced blood flow velocity with respect to the healthy control group, suggesting either a chronically reduced flow velocity for this population, or a relatively rapid decrease in flow velocity that is associated with the initiation of the hemodialysis procedure.…”

Section: Discussionmentioning

confidence: 99%

“…It has been found that specific cohorts of hemodialysis patients feature normal autoregulation, 32 and that the hemodialysis procedure does not directly impact cerebral autoregulation, 32,46 even though one case study reported that intermittent hemodialysis could negatively impact autoregulation. 47 However, some critically ill hemodialysis patients did feature a significantly impaired autoregulation, 48 and some comorbid conditions such as vascular disease and old age may account for impaired autoregulation in hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Reduced speed of microvascular blood flow in hemodialysis patients versus healthy controls: a coherent hemodynamics spectroscopy study

et al. 2014

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Abstract. We present a pilot clinical application of coherent hemodynamics spectroscopy (CHS), a technique to investigate cerebral hemodynamics at the microcirculatory level. CHS relies on frequency-resolved measurements of induced cerebral hemodynamic oscillations that are measured with near-infrared spectroscopy (NIRS) and analyzed with a hemodynamic model. We have used cyclic inflation (200 mmHg) and deflation of a pneumatic cuff placed around the subject's thigh at seven frequencies in the range of 0.03 to 0.17 Hz to generate CHS spectra and to obtain a set of physiological parameters that include the blood transit times in the cerebral microcirculation, the cutoff frequency for cerebral autoregulation, and blood volume ratios across the three different compartments. We have investigated five hemodialysis patients, during the hemodialysis procedure, and six healthy subjects. We have found that the blood transit time in the cerebral microcirculation is significantly longer in hemodialysis patients with respect to healthy subjects. No significant differences were observed between the two groups in terms of autoregulation efficiency and blood volume ratios. The demonstration of the applicability of CHS in a clinical setting and its sensitivity to the highly important cerebral microcirculation may open up new opportunities for NIRS applications in research and in medical diagnostics and monitoring.

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“…For instance the effect of a single hemodialysis session on the cerebral blood flow is controversially discussed. While one group found an improvement of cerebral blood flow due to dialysis [5] other groups do see either no effect at all [6], [7] or even a decrease in cerebral blood flow [8]. Also the effect of a single hemodialysis on arterial stiffness, the result of a complex interaction between structural and functional changes in the vessel wall, has not been the focus of clinical research, making it difficult to dissect the importance of abnormal arterial calcification from volume overload uremic toxins and various endocrine abnormalities [9], [10].…”

Section: Introductionmentioning

confidence: 92%

Effect of Isovolemic, Isothermic Hemodialysis on Cerebral Perfusion and Vascular Stiffness Using Contrast Computed Tomography and Pulse Wave Velocity

et al. 2013

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BackgroundPatients undergoing hemodialysis treatment have a six-fold increased risk for stroke relative to the general population. However, the effect of hemodialysis on cerebral blood flow is poorly studied and confounding factors like blood pressure and ultrafiltration as well as temperature changes have rarely been accounted for. The aim of our study was to use state-of-the-art technology to evaluate the effect of a single dialysis session on cerebral perfusion as well as on vascular stiffness.MethodsChronic hemodialysis patients (7 male/3 female, mean age 58 years) were recruited. Cerebral blood flow and arterial pulse wave velocity were measured before and immediately after a hemodialysis session. To exclude effects of volume changes we kept ultrafiltration to a minimum, allowing no change in body weight. Isothermic conditions were maintained by using the GENIUS single-pass batch-dialysis system with a high-flux polysulfone dialyser. Cerebral blood flow was measured by contrast-enhanced computed tomography. Pulse wave velocity was measured using the SphygmoCor (AtCor Medical, USA) device by a single operator.ResultsThis study shows for the first time that isovolemic, isothermic hemodialysis neither affected blood pressure or heart rate, nor total or regional cerebral perfusion. There was also no change in pulse wave velocity.ConclusionsMechanisms other than the dialysis procedure itself might be causative for the high incidence of ischemic strokes in this patient population. Moreover, the sole removal of uremic toxins does not lead to short-term effects on vascular stiffness, underlying the importance of volume control in this patient population.

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Online monitoring of cerebral hemodynamics during hemodialysis

Cited by 31 publications

References 21 publications

Systematic Review of Structural and Functional Neuroimaging Findings in Children and Adults with CKD

Systematic Review of Structural and Functional Neuroimaging Findings in Children and Adults with CKD

Reduced speed of microvascular blood flow in hemodialysis patients versus healthy controls: a coherent hemodynamics spectroscopy study

Effect of Isovolemic, Isothermic Hemodialysis on Cerebral Perfusion and Vascular Stiffness Using Contrast Computed Tomography and Pulse Wave Velocity

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