Factors affecting cerebral oxygenation in hemodialysis patients: cerebral oxygenation associates with pH, hemodialysis duration, serum albumin concentration, and diabetes mellitus.

Kiyonori Ito,Keiji Hirai,Mitsunobu Shindo,Honami Mori,Taisuke Kitano,Aoi Nabata,Yoshio Kaku,Izumi Yoshida,Haruhisa Miyazawa,Yuichiro Ueda,Susumu Ookawara,Masafumi Kakei,Masashi Yoshida,Taro Hoshino,Sawako Goto,Kaoru Tabei,Hodaka Yamada,Kandiah Jeyaseelan

doi:10.1371/journal.pone.0117474

Kiyonori Ito, Keiji Hirai + Show 16 more

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https://doi.org/10.1371/journal.pone.0117474

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Abstract

BackgroundPatients undergoing hemodialysis (HD) often develop cerebral disease complications. Furthermore, cerebral regional saturation of oxygen (rSO2) was previously reported to be significantly lower in HD patients than in healthy subjects. We aimed to identify the factors affecting the cerebral rSO2 in HD patients.MethodsFifty-four HD patients (38 men and 16 women; mean age, 67.7 ± 1.2 years, HD duration, 6.5 ± 1.9 years) were recruited. Cerebral rSO2 was monitored at the forehead before HD using an INVOS 5100C (Covidien Japan, Tokyo, Japan).ResultsThe rSO2 levels were significantly lower in HD patients compared with healthy controls (49.5 ± 1.7% vs. 68.9 ± 1.6%, p <0.001). Multiple regression analysis showed that cerebral rSO2 independently associated with pH (standardized coefficient: -0.35), HD duration (standardized coefficient: -0.33), and serum albumin concentration (standardized coefficient: 0.28). Furthermore, the rSO2 was significantly lower in HD patients with diabetes mellitus (DM), compared with patients without DM (46.8 ± 1.7% vs. 52.1 ± 1.8%, p <0.05).ConclusionsIn HD patients, cerebral rSO2 was affected by multiple factors, including pH, HD duration, and serum albumin concentration. Furthermore, this is the first report describing significantly lower levels of rSO2 in HD patients with DM than in those without DM.

Highlights

The rSO2 was significantly lower in HD patients with diabetes mellitus (DM), compared with patients without DM (46.8 ± 1.7% vs. 52.1 ± 1.8%, p
In HD patients, cerebral rSO2 was affected by multiple factors, including pH, HD duration, and serum albumin concentration
Near-infrared spectroscopy (NIRS) has been used as a tool to measure the regional saturation of oxygen, a marker of tissue oxygenation, at the frontal cerebral cortex in a variety of clinical situations, and has shown the change of critical balance between arterial oxygen delivery and cerebral oxygen consumption. [4,5,6,7] Cerebral rSO2 was reported to be significantly lower in HD patients than in healthy controls. [1,8] Few reports, have examined the relationship between cerebral oxygenation in HD patients and clinical parameters

Summary

Introduction

Central nervous system (CNS) dysfunction, such as uremic encephalopathy, cognitive impairment, and dementia, is a frequent complication of patients undergoing hemodialysis (HD). [1] Cerebrovascular accident (CVA) was described as the fourth leading cause of death in HD patients according to the annual report of the Japanese Society for Dialysis Therapy in 2011. [2] Magnetic resonance imaging (MRI) is a useful tool for detecting morphological changes in the brain and evaluating CVA; in addition, silent cerebral infarction detected by MRI has been found to associate with the severity of cognitive impairment in HD patients. [3] imaging methods like MRI and computed tomography can only provide information about organic lesions in the brain, and cannot evaluate the functional status such as cerebral blood flow and cerebral oxygenation. [4,5,6,7] Cerebral rSO2 was reported to be significantly lower in HD patients than in healthy controls. In this study, we aimed to elucidate the clinical factors influencing cerebral rSO2 in HD patients. Not all patients enrolled in this study underwent imaging examinations such as computed tomography and MRI for detecting cerebral ischemia, carotid artery stenosis or aortic stenosis. We excluded HD patients with apparent neurological disorder, history of cerebrovascular disease, and dementia; it could be considered that cerebral ischemia, carotid artery stenosis or aortic stenosis had no clinical effect in the HD patients enrolled in our study. Cerebral regional saturation of oxygen (rSO2) was previously reported to be significantly lower in HD patients than in healthy subjects. We aimed to identify the factors affecting the cerebral rSO2 in HD patients.

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