Abstract
Near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO2), and intradialytic tissue rSO2 measurements have been playing an important role in evaluating changes in tissue oxygenation in various clinical settings of hemodialysis (HD) therapy.However, few reports have described changes in hepatic oxygenation associated with body fluid management in overhydrated HD patients. We herein report an HD patient with congestive heart failure (CHF) that had improved systemic and tissue oxygenation, including in the brain and liver, during HD with ultrafiltration. A 73-year-old man undergoing HD was admitted to our hospital with CHF. After admission, HD with ultrafiltration was performed to adequately manage his body fluid excess. Because of deterioration of systemic oxygenation on admission, we monitored his percutaneous arterial oxygen saturation (SpO2) using a pulse oximeter and regional oxygen saturation (rSO2) in the brain and liver using an INVOS 5100c oxygen saturation monitor during HD. At HD initiation, his cerebral and hepatic rSO2 levels were relatively low, at 43.2% and 34.1%, respectively, in addition to the SpO2 of 88%. During HD with ultrafiltration, systemic oxygenation evaluated by SpO2 and tissue oxygenation by cerebral and hepatic rSO2 improved. Interestingly, the hepatic rSO2 ratio, defined as the ratio of rSO2 values at t (min) during HD and the initial rSO2 value before HD, increased larger than the cerebral rSO2 ratio during HD. After the adjustment of body fluid condition under the maintained SpO2 values, we confirmed the hepatic and cerebral SO2 ratio again during HD, and these two values changed nearly in the same manner. Throughout our experience, in this case, we confirmed a remarkable increase in hepatic rSO2 ratio relative to cerebral rSO2 ratio under a CHF status during HD, and these differences disappeared after the adjustment of the body fluid status.
Highlights
Cardiovascular disease is known as one of the major complications in chronic kidney disease (CKD) patients, including those on hemodialysis (HD)
It has been reported that cerebral rSO2 is low at the onset of acute congestive heart failure (CHF) and improves throughout the management of body fluid excess during HD with ultrafiltration [5], cerebral and hepatic rSO2 were maintained during HD without intradialytic hypotension [6,7]
We report an HD patient with CHF that had improved systemic and tissue oxygenation, including in the brain and liver, during HD
Summary
Cardiovascular disease is known as one of the major complications in chronic kidney disease (CKD) patients, including those on hemodialysis (HD). Adequate body fluid management is necessary to prevent the onset of cardiovascular disease, including congestive heart failure (CHF), and to improve patient prognosis [3,4]. His chest radiograph showed perihilar vascular engorgement, and he was diagnosed with acute CHF due to excess body fluid. At HD initiation, cerebral and hepatic rSO2 levels were 43.2% and 34.1%, respectively, in addition to the SpO2 of 88%, even with the use of noninvasive positive pressure ventilation with oxygen administration Throughout this HD procedure, systemic oxygenation evaluated by SpO2 and tissue oxygenation by cerebral and hepatic rSO2 improved (Figure 1a), and respiratory management using noninvasive positive pressure ventilation was able to be completed at the end of HD. 1a: under a CHF status with NPPV, 1b: under stable HD in room air; SpO2, saturation of percutaneous oxygen; rSO2, regional saturation of oxygen; HD, hemodialysis; CHF, congestive heart failure; NPPV, noninvasive positive-pressure ventilation; UFR, ultrafiltration; FiO2, fraction of inspiratory oxygen
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