The Relationship between Cerebrovascular Reactivity and Cerebral Oxygenation during Hemodialysis

Abstract

BackgroundPatients with kidney failure treated with hemodialysis (HD) may be at risk for cerebral hypoperfusion due to HD-induced BP decline in the setting of impaired cerebral autoregulation. Cerebrovascular reactivity (CVR), the cerebrovascular response to vasoactive stimuli, may be a useful indicator of cerebral autoregulation in the HD population and identify those at risk for cerebral hypoperfusion. We hypothesize that CVR combined with intradialytic BP changes will be associated with declines in cerebral oxygenation saturation (ScO2) during HD.MethodsParticipants completed the MRI scans on a non-HD day and cerebral oximetry during HD. We measured CVR with resting-state fMRI (rs-fMRI) without a gas challenge and ScO2 saturation with near-infrared spectroscopy. Regression analysis was used to examine the relationship between intradialytic cerebral oxygen desaturation, intradialytic BP, and CVR in different gray matter regions.ResultsTwenty-six patients on HD had complete data for analysis. Sixteen patients were men, 18 had diabetes, and 20 had hypertension. Mean±SD age was 65.3±7.2 years, and mean±SD duration on HD was 11.5±9.4 months. CVR in the anterior cingulate gyrus (ACG; P=0.03, r2=0.19) and insular cortex (IC; P=0.03, r2=0.19) regions negatively correlated with decline in intradialytic ScO2. Model prediction of intradialytic ScO2 improved when including intradialytic BP change and ultrafiltration rate to the ACG rsCVR (P<0.01, r2=0.48) and IC rsCVR (P=0.02, r2=0.35) models, respectively.ConclusionsWe found significant relationships between regional rsCVR measured in the brain and decline in intradialytic ScO2. Our results warrant further exploration of using CVR in determining a patient’s risk of cerebral ischemic injury during HD.

Research Progress on Cognitive Frailty in Older Adults with Chronic Kidney Disease

“…Cognitive function can be impaired by dialysis [37][38][39]. Haemodynamic instability in haemodialysis (HD) may lead to insufficient cerebral perfusion in patients undergoing HD, which is the cause of cognitive impairment in patients with ESRD [37].…”

“…Cognitive function can be impaired by dialysis [37][38][39]. Haemodynamic instability in haemodialysis (HD) may lead to insufficient cerebral perfusion in patients undergoing HD, which is the cause of cognitive impairment in patients with ESRD [37]. Wolfgram et al demonstrated that monitoring cerebral perfusion in patients undergoing HD may delay cognitive frailty [40].…”