Hepatic Oxygenation Changes and Symptomatic Intradialytic Hypotension.

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE Kidney & blood pressure research Pub Date : 2024-01-01 Epub Date: 2024-05-10 DOI:10.1159/000539277

Susumu Ookawara, Kiyonori Ito, Yusuke Sasabuchi, Yuichiro Ueda, Junki Morino, Shohei Kaneko, Yuko Mutsuyoshi, Taisuke Kitano, Keiji Hirai, Yoshiyuki Morishita

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Abstract

Introduction: Clinical studies on differences among changes in cerebral and hepatic oxygenation during hemodialysis (HD) in patients with and without intradialytic hypotension (IDH) are limited. We investigated changes in intradialytic cerebral and hepatic oxygenation before systolic blood pressure (SBP) reached the nadir during HD and compared these differences between patients with and without symptomatic IDH.

Methods: We analyzed data from 109 patients with (n = 23) and without (n = 86) symptomatic IDH who were treated with HD. Cerebral and hepatic regional oxygen saturation (rSO2), as a marker of tissue oxygenation and circulation, was monitored during HD using an INVOS 5100c oxygen saturation monitor. Changes in cerebral or hepatic rSO2 when SBP reached the nadir during HD were compared between the groups of patients.

Results: The cerebral rSO2 before HD in patients with and without symptomatic IDH was 49.7 ± 11.2% and 51.3 ± 9.1% (p = 0.491). %Changes in cerebral rSO2 did not significantly differ between the two groups from 60 min before the SBP nadir during HD. Hepatic rSO2 before HD in patients with and without symptomatic IDH was 58.5 ± 15.4% and 57.8 ± 15.9% (p = 0.869). The %changes in hepatic rSO2 were significantly lower in patients with symptomatic IDH than in those without throughout the observational period (p < 0.001). We calculated the area under the receiver operating characteristic curve (AUC) and estimated cutoff values for changes in hepatic rSO2 as a symptomatic IDH predictor. The predictive ability at 5 and 40 min before symptomatic IDH onset was excellent, with AUCs and cutoff values of 0.847 and 0.841, and -10.9% and -5.0%, respectively.

Conclusions: Hepatic oxygenation significantly decreased more in patients with symptomatic IDH before its onset, than in those without symptomatic IDH, whereas changes in cerebral oxygenation did not differ. Evaluating changes in hepatic oxygenation during HD might help to predict symptomatic IDH.

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肝氧合变化与症状性椎管内低血压

简介：关于血液透析（HD）期间有无椎管内低血压（IDH）患者脑氧合和肝氧合变化差异的临床研究非常有限。我们研究了血液透析过程中收缩压（SBP）达到最低点之前椎管内脑氧合和肝氧合的变化，并比较了有症状和无症状 IDH 患者之间的差异：我们分析了 109 名接受 HD 治疗的有症状 IDH 患者（23 人）和无症状 IDH 患者（86 人）的数据。在 HD 治疗期间，使用 INVOS 5100c 氧饱和度监测仪监测作为组织氧合和循环标志物的大脑和肝脏区域氧饱和度 (rSO2)。比较各组患者在 HD 期间 SBP 达到最低点时大脑或肝脏 rSO2 的变化：结果：有症状和无症状 IDH 患者 HD 前的脑 rSO2 分别为 49.7 ± 11.2% 和 51.3 ± 9.1%（p = 0.491）。从 HD 期间 SBP 最低点前 60 分钟开始，两组患者的脑 rSO2 变化无明显差异。有症状和无症状 IDH 患者 HD 前的肝脏 rSO2 分别为 58.5 ± 15.4% 和 57.8 ± 15.9% (p = 0.869)。在整个观察期间，有症状的 IDH 患者的肝脏 rSO2 变化百分比明显低于无症状的 IDH 患者（p < 0.001）。我们计算了接收者操作特征曲线下面积（AUC），并估计了肝脏 rSO2 变化作为无症状 IDH 预测指标的临界值。无症状 IDH 发病前 5 分钟和 40 分钟的预测能力极佳，AUC 和临界值分别为 0.847 和 0.841，-10.9% 和 -5.0%：与无症状IDH患者相比，有症状IDH患者在发病前的肝氧饱和度明显下降，而脑氧饱和度的变化则没有差异。在血液透析过程中评估肝氧合的变化可能有助于预测有症状的IDH。

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来源期刊

Kidney & blood pressure research 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal comprises both clinical and basic studies at the interface of nephrology, hypertension and cardiovascular research. The topics to be covered include the structural organization and biochemistry of the normal and diseased kidney, the molecular biology of transporters, the physiology and pathophysiology of glomerular filtration and tubular transport, endothelial and vascular smooth muscle cell function and blood pressure control, as well as water, electrolyte and mineral metabolism. Also discussed are the (patho)physiology and (patho) biochemistry of renal hormones, the molecular biology, genetics and clinical course of renal disease and hypertension, the renal elimination, action and clinical use of drugs, as well as dialysis and transplantation. Featuring peer-reviewed original papers, editorials translating basic science into patient-oriented research and disease, in depth reviews, and regular special topic sections, ''Kidney & Blood Pressure Research'' is an important source of information for researchers in nephrology and cardiovascular medicine.