Abstract: FR-PO821

Intradialytic Hemodynamics and Cerebral Perfusion

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Author

  • Wolfgram, Dawn F., Zablocki VA Medical Center, Milwaukee, Wisconsin, United States
Background

Persons with end-stage renal disease on hemodialysis (HD) have significant cerebral ischemic disease and atrophy noted on brain imaging. Hemodynamic instability during HD may lead to cerebral hypo-perfusion and resultant ischemic injury. Risk of cerebral hypo-perfusion may be higher in a subset of HD persons with increased drop in blood pressure during HD. We sought to describe the changes in cerebral perfusion during HD and the relationship to changes in intradialytic blood pressures (BP) in a cohort of HD patients.

Methods

We used a clinically validated method of continuous cerebral oximetry monitoring as a marker of cerebral perfusion during HD. Demographic variables and co-morbidities were collected on each participant, along with hemodialysis variables of intradialytic BP, fluid removal and duration of HD session. Descriptive statistics and linear regression analysis was used to analyze the data.

Results

Thirteen participants were enrolled with 11 participants completing the study and included in the analysis. The mean (SD) age was 66.8 (7.7) years. All participants had hypertension and 73% had diabetes. Diabetes was the cause of ESRD in 55% of participants. The mean (SD) change in cerebral oximetry during HD was -3.5% (2.6). In participants with greater than 20mmHg drop in SBP during HD (n= 7) the mean (SD) change in cerebral oximetry was -4.1% (3.2) vs -2.6 (0.8) in those with less than 20mmHg drop in SBP (p = 0.39). In participant with diabetes the mean (SD) change in cerebral oximetry was -4.2 (3.2) vs -2.3 (1.3) in participants without diabetes (p = 0.24). In participants with both diabetes and a greater than 20mmHg drop during dialysis there was a change in cerebral oximetry of -5.1 (3.1) vs -2.2 (1.3) in participants not meeting both criteria (p = 0.06). In four participants there was a significant association between SBP and cerebral oximetry during HD.

Conclusion

On average cerebral oximetry declines during HD and in some participants the decline may be related to drop in systemic BP during HD. Greater intradialtyic drop in BP in the setting of diabetes may increase risk of cerebral hypo-perfusion and ischemic injury. Analysis of our data was limited due to small sample size and increase in participant number is needed to determine the relationship between changes in intradialytic blood pressures and cerebral oximetry.

Funding

  • Private Foundation Support