Journal Article

Cerebral blood flow decreases during intermittent hemodialysis in patients with acute kidney injury, but not in patients with end-stage renal disease

Giuseppe Regolisti, Umberto Maggiore, Carola Cademartiri, Aderville Cabassi, Alberto Caiazza, Stefano Tedeschi, Elio Antonucci and Enrico Fiaccadori

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 28, issue 1, pages 79-85
Published in print January 2013 | ISSN: 0931-0509
Published online June 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs182
Cerebral blood flow decreases during intermittent hemodialysis in patients with acute kidney injury, but not in patients with end-stage renal disease

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Background

Cerebral blood flow (CBF) may decrease during intermittent hemodialysis (IHD). Patients with acute kidney injury (AKI) may be more vulnerable to cerebral hypoperfusion than patients with end-stage renal disease (ESRD), due to concomitant critical illness and hemodynamic instability.

Methods

In this observational, prospective study, we measured mean flow velocity at the level of the middle cerebral artery by transcranial Doppler at the start, after 2 h and at the end of a hemodialysis session in 15 consecutive patients with AKI and critical illness referred to the nephrological intensive care unit of a university hospital and in 12 patients with ESRD on regular treatment thrice weekly, who served as controls. We compared end-dialysis changes from baseline in mean flow velocity between the study groups and examined the correlation between this change and that of other relevant clinical parameters.

Results

Mean flow velocity decreased significantly at end-dialysis in the patients with AKI, but not in those with ESRD (P = 0.02). This difference persisted after adjusting for baseline mean flow velocity and net ultrafiltration volume. No significant correlations were found in either group between changes in mean flow velocity and changes in mean blood pressure (AKI: r = −0.27, P = 0.34; ESRD: r = 0.15, P = 0.68), SUN (AKI: r = −0.33, P = 0.25; ESRD: r = 0.06, P = 0.85), plasma HCO3 (AKI: r = −0.52, P = 0.24; ESRD: r = −0.18, P = 0.59), hematocrit (AKI: r = 0.08, P = 0.71; ESRD: r = −0.19, P = 0.65) or arterial oxygen content (AKI: r = −0.17, P = 0.36; ESRD: r = −0.33, P = 0.43).

Conclusions

Our data suggest that AKI patients may be more vulnerable than ESRD patients to cerebral hypoperfusion during IHD. Our findings do not support a clear-cut role of rapid changes in blood osmolarity, rheological properties or vasoreactivity of the cerebral circulation to O2 supply in modulating CBF during hemodialysis.

Keywords: acute kidney injury; cerebral blood flow; hemodialysis; transcranial Doppler

Journal Article.  4591 words.  Illustrated.

Subjects: Nephrology

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