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Abstract: TH-PO341

Residual Renal Function Loss in Hemodialysis Patients: Is Kidney Stunning the Culprit and Can Dialysate Cooling Help?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Marants, Raanan, University of Western Ontario, London, Ontario, Canada
  • Qirjazi, Elena, University of Western Ontario, London, Ontario, Canada
  • Grant, Claire, University of Nottingham, Nottingham, United Kingdom
  • Lee, Ting, University of Western Ontario, London, Ontario, Canada
  • McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada

Group or Team Name

  • The Lilibeth Caberto Kidney Clinical Research Unit
Background

Residual renal function (RRF) declines in patients with ESRD after hemodialysis (HD) initiation, necessitating more aggressive fluid removal in subsequent sessions. It has been postulated that recurrent HD-induced renal ischemic insults lead to RRF decline, while dialysate cooling (DC), a feasible intervention which does not burden patient treatment, has been shown to ameliorate HD-induced circulatory stress in the heart and brain. The purpose of this work was to assess the effects of HD on renal hemodynamics using CT perfusion imaging and to explore DC as a protective intervention against renal intradialytic circulatory stress and RRF decline.

Methods

26 patients provided written informed consent. All patients received standard (36.5°C) HD and a subgroup of 15 patients were randomized to receive either standard or cooled (35°C) HD first in a 2-visit crossover study design. For each visit, CT perfusion imaging was performed at three timepoints (before, 3 hrs into, and after HD) on a 256-slice CT scanner (GE Healthcare) without interrupting HD treatment. Parametric renal perfusion maps were generated and used to measure kidney blood flow.

Results

Renal perfusion loss (‘kidney stunning’) was observed in 63% (33/52) of kidneys during standard HD but declined to 50% of kidneys during cooled HD. The drop in renal perfusion at 3 hrs into HD was statistically significant (p<0.05) for the standard HD case but not for the cooled HD case. Figure 1 summarizes the per kidney perfusion measurements.

Conclusion

HD causes an acute drop in renal perfusion, and it may be these recurring ischemic insults over many sessions which result in irreversible renal tissue damage and RRF reduction. However, DC ameliorates these perfusion changes and may help slow RRF decline in HD patients.

Figure 1: Percent of baseline renal perfusion before, 3 hours into, and after HD. Results are given as average ± standard error of the mean for 26 patients (52 kidneys).