Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis

Abstract

Background Cerebral and myocardial hypoperfusion occur during hemodialysis in adults. Pediatric patients receiving chronic hemodialysis have fewer cardiovascular risk factors, yet cardiovascular morbidity remains prominent. Methods We conducted a prospective observational study of pediatric patients receiving chronic hemodialysis to investigate whether intermittent hemodialysis is associated with adverse end organ effects in the heart or with cerebral oxygenation (regional O2 saturation [rSO2]). We assessed intradialytic cardiovascular function and rSO2, using noninvasive echocardiography to determine myocardial strain and continuous noninvasive nearinfrared spectroscopy for rSO2. We measured changes in blood volume and central venous oxygen saturation (mCVO2) were pre-, mid-, and post-hemodialysis. Results The study included 15 patients (median age, 12 years; median hemodialysis vintage 13.2 [9, 24] months were included. Patients were asymptomatic. The rSO2 did not change during hemodialysis, whereas mCVO2 decreased significantly, from 73% to 64.8 %. Global longitudinal strain of the myocardium worsened significantly by mid-hemodialysis and persisted post-hemodialysis. The ejection fraction remained normal. Lower systolic blood pressure and faster blood volume change were associated with worsening myocardial strain; only blood volume change was significant in multivariate analysis (β coefficient, -0.3; 95% confidence interval [95% CI], −0.38 to −0.21; P=0.0001). Blood volume change was also associated with a significant decrease in mCVO2 (β coefficient 0.42; 95% CI, 0.07 to 0.76; P=0.001). Access, age, hemodialysis vintage, and ultrafiltration volume were not associated with worsening strain. Conclusion s Unchanged rSO2 suggested that cerebral oxygenation was maintained during hemodialysis. However, despite maintained ejection fraction, intradialytic myocardial strain worsened in pediatric hemodialysis and was associated with blood volume change. The effect of hemodialysis on individual organ perfusion in pediatric versus adult patients receiving hemodialysis might differ.

Pre- and Post-Hemodialysis Cerebral Blood Flow Velocity in Patients With End-Stage Renal Disease

“…Another cohort of 15 pediatric patients receiving chronic HD identified no significant difference between pre and post-HD values of cerebral rSO2. 21 Polinder-Bos and colleagues indicated a decrease in absolute rSO2 values at the end of HD in comparison to values at the beginning of HD were similar to our study. Moreover, Polinder-Bos et al 22 confirmed their findings through simultaneous positron emission tomography studies including 12 patients with ESRD.…”

“…Ito et al 20 demonstrated an increase in follow-up cerebral rSO2 values compared with the values at the beginning of HD, which may be due to an improvement in hemoglobin levels after dialysis. Another cohort of 15 pediatric patients receiving chronic HD identified no significant difference between pre and post-HD values of cerebral rSO2 21 . Polinder-Bos and colleagues indicated a decrease in absolute rSO2 values at the end of HD in comparison to values at the beginning of HD were similar to our study.…”

Reversal of neurovascular decoupling and cognitive impairment in patients with end‐stage renal disease during a hemodialysis session: Evidence from a comprehensive fMRI analysis

“…In the present study, we found a significant increase in CBF in patients with ESRD who had anemia, which may be related to a reduction in blood viscosity and brain tissue hypoxia (Kuwabara et al, 2002 ). HD treatment concentrates the blood of patients with ESRD, resulting in a relative increase in hemoglobin level, red blood cell count, and hematocrit level, and eventually increasing blood viscosity and enhancing oxygen transport capability (Idrovo et al, 2021 ; Kuwabara et al, 2002 ). Several studies have demonstrated that increased CBF (Jiang et al, 2016 ) and decreased spontaneous neural activity (H. Lu et al, 2019 ; Ma et al, 2015 ) are closely linked to anemia in patients with ESRD, which implies that anemia could be a key factor related to brain dysfunction in ESRD (Marzban et al, 2021 ).…”