Cerebral hemodynamics among non-diabetic hemodialysis patients

Maha Abdelmoneim Behairy,Abdelbassit El Shaarawy,Mahmoud Sadek,Ahmed Elsadek

doi:10.1186/s41983-019-0126-3

Maha Abdelmoneim Behairy, Abdelbassit El Shaarawy + Show 2 more

Open Access

https://doi.org/10.1186/s41983-019-0126-3

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Abstract

BackgroundCerebrovascular accidents and cognitive impairment is a frequent complication of end-stage renal disease (ESRD) on regular hemodialysis (HD).ObjectiveTo evaluate cerebral circulation hemodynamics in non-diabetic prevalent hemodialysis patients by transcranial Doppler (TCD).Patients and methodsThe cross-sectional study included 50 ESRD patients on regular hemodialysis > 6 months in Ain Shams University Hospitals, Cairo, Egypt. Diabetic patients; chronic liver disease patients Child-Pugh class B or C; smokers; history of evident of cardiac, peripheral, or cerebrovascular insult; uncontrolled hypertension; anemia; collagen disease; and active infection were excluded from the study. An assessment of cerebral circulation hemodynamics by TCD in non-dialysis day to examine mean flow velocity (MFV) in the middle cerebral artery (MCA) and posterior cerebral artery (PCA).ResultsAn assessment of cerebral circulation hemodynamics revealed that 16 (32%) of the patients showed decrease MFV in MCA and 30 (60%) were normal. Regarding MFVs in PCA, 13 (26%) of the patients showed decrease MFVs, 33 (66%) were normal, and 4 (8%) of the patients failed due to poor bone window, significant reduction of MCV and PCA velocities in HD with urea reduction ratio < 65%, and a significantly negative correlation of MFV, PCA, and hemoglobin level (P < 0.05).ConclusionThere is a high frequency rate of decreased MCA and PCA MFV (32%, 28%), respectively, among non-diabetic prevalent hemodialysis patients with significant correlation to hemodialysis adequacy.

Highlights

Patients with end-stage renal disease (ESRD) are at increased risk of cerebrovascular diseases such as encephalopathy, cerebrovascular strokes, cognitive impairment, and dementia with a risk higher than the general population [1]
Many studies reported the significant correlation between relative changes in cerebral blood velocity and changes in cerebral blood flow over a wide range of flow velocities, and it seems that transcranial Doppler recording of blood velocity can provide a useful indication of the real changes in the underlying cerebral blood flow [4]
The aim of this study is to evaluate cerebral hemodynamics in prevalent non-diabetic hemodialysis patients by transcranial Doppler (TCD)

Summary

Introduction

Patients with end-stage renal disease (ESRD) are at increased risk of cerebrovascular diseases such as encephalopathy, cerebrovascular strokes, cognitive impairment, and dementia with a risk higher than the general population [1]. The risk of stroke as a frequent complication of uremia, which can result from acute cerebral blood flow reduction, is five times higher in dialysis patients than the general population [2]. A lower cerebral blood flow is associated with hemodialysis treatment-related factors, a higher ultrafiltration volume, Transcranial Doppler ultrasound is a non-invasive technique for the evaluation of cerebral blood flow velocities with the advantages of the possibility of continuous, real-time recording. Cerebrovascular accidents and cognitive impairment is a frequent complication of end-stage renal disease (ESRD) on regular hemodialysis (HD)

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Conclusion