Abstract: SA-PO416
Impaired Cerebrovascular Reactivity Is a Risk Factor for Cerebral Ischemia during Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wolfgram, Dawn F., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Seigworth, Claire C., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Grassl, Isabelle L., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Gao, Yan, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Background
Patients with end-stage kidney disease treated with hemodialysis (HD) have significant atrophy and ischemic type lesions noted on brain imaging. Circulatory stress during HD can lead to drops in systemic blood pressure. During change in blood pressure, cerebrovascular reactivity (CVR) is needed to maintain stable cerebral perfusion. Due to the high prevalence of vascular disease in HD patients, impaired CVR may be common and place patients at higher risk for cerebral hypoperfusion and ischemia during HD.
Methods
We used transcranial Doppler (TCD) to monitor change in cerebral blood flow velocity during induced hypercapnia to measure CVR in HD patients. We monitored intradialytic cerebral perfusion using continuous cerebral oxygen saturation measurements during HD sessions, calculating both maximum drop and overall decline in cerebral oxygen saturation during the HD session. We used linear regression to measure the association between CVR and decline in cerebral perfusion during HD, adjusting for covariates.
Results
We completed the CVR measure in 42 HD patients. The mean (SD) age of the cohort was 58.5 (11.0) years, 59.5% had diabetes, and 87.7% had hypertension. The mean CVR for the cohort was 2.7 (1.6) %/mmHg, with 42.9% having a CVR < 2.0%/mmHg, consistent with impaired CVR. The maximum drop in cerebral oxygen saturation was a decrease of 5.9% (2.8) and overall decline was 2.2% (2.5). A lower CVR was associated with greater drop and overall decline in cerebral oxygen saturation during HD (p = 0.01 for both). This relationship was strengthened when accounting for changes in blood pressure during HD.
Conclusion
Lower CVR is associated with decline in cerebral perfusion during HD. This measurement may be able to help identify patients who are at highest risk for cerebral ischemic injury during HD and help understand the pathophysiology of intradialytic cerebral hypoperfusion.
Funding
- NIDDK Support