Faculty Collaboration Database

The Relationship between Cerebrovascular Reactivity and Cerebral Oxygenation during Hemodialysis. J Am Soc Nephrol 2022 Aug;33(8):1602-1612

Date

07/02/2022

Pubmed ID

35777782

Pubmed Central ID

PMC9342630

DOI

10.1681/ASN.2021101353

Scopus ID

2-s2.0-85135392530 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Patients 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.

METHODS: Participants 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.

RESULTS: Twenty-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.

CONCLUSIONS: We 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.

Author List

Richerson WT, Schmit BD, Wolfgram DF

Authors

Brian Schmit PhD Professor in the Biomedical Engineering department at Marquette University
Dawn Felicity Wolfgram MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Brain
Cerebrovascular Circulation
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Oximetry
Oxygen
Renal Dialysis