Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients.

Susumu Ookawara,Yoshiyuki Morishita,Yusuke Sasabuchi,Hirofumi Shimoyama,Hideyuki Hayasaka,Takayuki Uchida,Sojiro Imai,Masaya Kofuji,Yasushi Onishi,Keita Horigome,Satoru Imada,Mitsutoshi Shindo,Haruhisa Miyazawa,Keiji Hirai,Toshiko Akikawa,Kaoru Tabei,Noriko Wada,Satoshi Kiryu,Akira Watanabe ,Ito K

doi:10.1371/journal.pone.0236720

Susumu Ookawara, Yoshiyuki Morishita + Show 18 more

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https://doi.org/10.1371/journal.pone.0236720

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Abstract

Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO2) of hemodialysis (HD) patients is limited. We aimed to identify these associations to consider a target Hb level for renal anemia management. This study included 375 HD patients. Cerebral rSO2 before HD was monitored using the INVOS 5100c oxygen saturation monitor. Multivariable linear regression analysis showed that cerebral rSO2 was independently associated with natural logarithm (Ln)-HD duration (standardized coefficient: -0.36), mean blood pressure (standardized coefficient: 0.13), pH (standardized coefficient: -0.10), serum albumin (standardized coefficient: 0.14), presence of diabetes mellitus (standardized coefficient: -0.20), and Hb level (standardized coefficient: 0.29). Furthermore, a generalized linear model with restricted cubic spline function was used to investigate the non-linear association between cerebral rSO2 and Hb levels. In the multivariable analysis for the adjustment with Ln-HD duration, mean blood pressure, pH, serum albumin, and presence of diabetes mellitus, a linear relationship was demonstrated between the two variables (p for linearity = 0.79). Hb levels revealed the positive and significant association with cerebral rSO2 in this study. Moreover, the relationship between cerebral rSO2 and Hb level was proven to be linear. Therefore, the target Hb level in renal anemia management would be considered to be the upper limits for the appropriate management of renal anemia by previous guidelines and position statement from the viewpoint of maintaining cerebral oxygenation in HD patients.

Highlights

Renal anemia is a common complication in patients with advanced chronic kidney disease (CKD), including hemodialysis (HD) patients
Under a severe anemic status caused by the progression of renal anemia, it is largely responsible for the significant detrimental effects of CKD including decreases in exercise capacity, immune response, cognitive function, and nutrition, and increases in depression, cardiac dysfunction, morbidity, and mortality [1]
The Kidney Disease Improving Global Outcomes Guidelines [2], the European Renal Best Practice position statement [3], and Guidelines for Renal Anemia edited by the Japanese Society for Dialysis Therapy [4], have been proposed for the appropriate management of renal anemia, and are clinically important to standardize renal anemia management

Summary

Introduction

Renal anemia is a common complication in patients with advanced chronic kidney disease (CKD), including hemodialysis (HD) patients. The Kidney Disease Improving Global Outcomes Guidelines [2], the European Renal Best Practice position statement [3], and Guidelines for Renal Anemia edited by the Japanese Society for Dialysis Therapy [4], have been proposed for the appropriate management of renal anemia, and are clinically important to standardize renal anemia management These guidelines and position statement were determined by randomized controlled trials and clinical trials such as comparison of the quality of life and differences in mortality [5,6,7,8,9,10,11]. Regarding the association between cerebral rSO2 and clinical parameters, the Hb levels did not affect cerebral rSO2 in HD patients with well-maintained Hb levels [13,14], whereas a significant increase in cerebral rSO2 was observed in response to the Hb increase after blood transfusion in severely anemic HD patients [15]. This study aimed to investigate the association of Hb levels with cerebral rSO2 values under the adjustment with other significant clinical parameters affecting cerebral oxygenation, and determine the target Hb level from the viewpoint of maintaining and improving cerebral oxygenation in HD patients

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