Abstract
The hepato-splanchnic circulation directly influences oxygenation of the abdominal organs and plays an important role in compensating for the blood volume reduction that occurs in the central circulation during hemodialysis (HD) with ultrafiltration. However, the hepato-splanchnic circulation and oxygenation cannot be easily evaluated in the clinical setting of HD therapy. We included 185 HD patients and 15 healthy volunteers as the control group in this study. Before HD, hepatic regional oxygen saturation (rSO2), a marker of hepatic oxygenation reflecting the hepato-splanchnic circulation and oxygenation, was monitored using an INVOS 5100c oxygen saturation monitor. Hepatic rSO2 was significantly lower in patients undergoing HD than in healthy controls (56.4 ± 14.9% vs. 76.2 ± 9.6%, p < 0.001). Multivariable regression analysis showed that hepatic rSO2 was independently associated with body mass index (BMI; standardized coefficient: 0.294), hemoglobin (Hb) level (standardized coefficient: 0.294), a history of cardiovascular disease (standardized coefficient: -0.157), mean blood pressure (BP; standardized coefficient: 0.154), and serum albumin concentration (standardized coefficient: 0.150) in Model 1 via a simple linear regression analysis. In Model 2 using the colloid osmotic pressure (COP) in place of serum albumin concentration, the COP (standardized coefficient: 0.134) was also identified as affecting hepatic rSO2. Basal hepatic oxygenation before HD might be affected by BMI, Hb levels, a history of cardiovascular disease, mean BP, serum albumin concentration, and the COP. Further prospective studies are needed to clarify whether changes in these parameters, including during HD, affect the hepato-splanchnic circulation and oxygenation in HD patients.
Highlights
Body fluid management is an important aspect of hemodialysis (HD), and ultrafiltration is essential in achieving each patient’s target body weight
The mean hepatic rSO2 was significantly lower in patients undergoing HD than in healthy controls (56.4 ± 14.9% vs. 76.2 ± 9.6%, p < 0.001; Fig 2)
Hepatic rSO2 was significantly positively correlated with body mass index (BMI), mean blood pressure (BP), interdialytic weight gain, Hb levels, the serum creatinine concentration, the serum albumin concentration, the colloid osmotic pressure, and the use of renin-angiotensinaldosterone system (RAS) inhibitors and calcium channel blockers and negatively correlated with age, a history of cardiovascular disease, the aspartate aminotransferase level, and Ln-C-reactive protein (CRP) levels
Summary
Body fluid management is an important aspect of hemodialysis (HD), and ultrafiltration is essential in achieving each patient’s target body weight. Hepatic rSO2 values, which were recently used to evaluate the hepatosplanchnic circulation and oxygenation of patients undergoing HD, were reportedly maintained during HD without intradialytic hypotension [9], and significantly increased in response to an increase in hemoglobin (Hb) level by intradialytic blood transfusion [10]. Few reports have examined the association between hepatic rSO2 before HD and clinical factors in patients undergoing HD, and the clinical factors that affect hepatic rSO2 remain unknown. Clarification of these factors might provide guidance for maintaining or improving patient hepato-splanchnic circulation and oxygenation status in the clinical setting of HD therapy. This study aimed to elucidate the clinical factors influencing hepatic rSO2 in patients undergoing HD
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