Kidney Week

Abstract: TH-OR010

Hemodialysis Induces Decline in Cerebral Blood Flow in Elderly Patients: A Quantitative [15O]H2O-PET-CT Study

Session Information

• Cardiovascular Outcomes in Hemodialysis
  November 02, 2017 | Location: Room 277, Morial Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Polinder-Bos, Harmke A., University Medical Center Groningen, Groningen, Netherlands

Harmke A. Polinder-Bos, MD



https://www.linkedin.com/in/harmkepolinder-bos/

• Vállez, David, University Medical Center Groningen, Groningen, Netherlands

David Vállez,

• Kuipers, Johanna J., Dialyse Centrum Groningen, Groningen, Netherlands

Johanna J. Kuipers,

• Elting, Jan willem, University Medical Center Groningen, Groningen, Netherlands

Jan willem Elting,

• Aries, Marcel, Maastricht University Medical Center, Maastricht, Netherlands

Marcel Aries,

• Groen, Henk, University Medical Center Groningen, Groningen, Netherlands

Henk Groen,

• Krijnen, Wim, Hanze University of Applied Sciences, Groningen, Netherlands

Wim Krijnen,

• Willemsen, Antoon, University Medical Center Groningen, Groningen, Netherlands

Antoon Willemsen,

• van Laar, Peter Jan, University Medical Center Groningen, Groningen, Netherlands

Peter Jan van Laar,

• Strijkert, Fijanne, University Medical Center Groningen, Groningen, Netherlands

Fijanne Strijkert,

• Luurtsema, Gert, University Medical Center Groningen, Groningen, Netherlands

Gert Luurtsema,

• Slart, Riemer hja, University Medical Center Groningen, Groningen, Netherlands

Riemer hja Slart,

• Westerhuis, Ralf, Dialyses Center Groningen, Groningen, Netherlands

Ralf Westerhuis,

• Gansevoort, Ron T., University Medical Center Groningen, Groningen, Netherlands

Ron T. Gansevoort,

• Gaillard, Carlo A., University Medical Center Groningen, Groningen, Netherlands

Carlo A. Gaillard,

• Franssen, Casper F.M., University Medical Center Groningen, Groningen, Netherlands

Casper F.M. Franssen,

Background

The transition to hemodialysis (HD) is associated with a decline of cognitive function and an increased incidence of cerebrovascular accidents and white matter lesions. It has been hypothesized that the repetitive circulatory stress of HD induces ischemic injury to the brain, but the mechanism is unclear. Despite the sophisticated regulation of the brain to keep the cerebral blood flow (CBF) steady, HD might induce a fall in CBF. We evaluated whether a change in CBF occurred during a HD session, measured by [¹⁵O]H₂O-PET-CT, which is considered the gold standard for measuring CBF.

Methods

Twelve maintenance HD patients aged ≥65 years, (5 females, 7 males) with a median dialysis vintage of 3.8 years, participated in this observational study. During a single HD session three [¹⁵O]H₂O-PET-CT scans were performed: before, early after the start, and at the end of HD. For each PET-CT scan a bolus injection of [¹⁵O]H₂O was administered intravenously in the non-dialysis access arm, and arterial blood was continuously sampled from the arteriovenous fistula. Dialysate temperature was 36.5°C. Mixed linear models were used to study global and regional CBF change during HD.

Results

Mean arterial pressure declined non-significantly from 101±11 before HD to 93±17mmHg at the end of HD, whereas pCO₂ remained stable. The PET-CT scan at the end of the HD session showed a significant 10 (±15)% decline in global CBF from a mean of 34.5 to 30.5 ml/100g/min (difference: -4.0 ml/100g/min [-7.3; -0.7], P=0.01). CBF fell significantly in all regions of interest: the frontal, parietal, temporal, and occipital lobes, cerebellum and thalamus. The largest CBF reductions were observed in the thalamus (-5.2 ml/100g/min [-8.8; -1.6], P=0.001) and frontal lobe (-5.1 ml/100g/min [-7.7; -2.5], P<0.0001).

Conclusion

Conventional HD induces a significant reduction in CBF in elderly patients. This finding fits well into the hypothesis that HD induces ischemic injury to the brain, which in the long-term might contribute to cognitive function decline, especially in elderly HD patients.