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Abstract: TH-PO335

Hepatic Response to Cooler Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Qirjazi, Elena, Western University, London, Ontario, Canada
  • Marants, Raanan, Western University, London, Ontario, Canada
  • Mio, Megan A., Western University, London, Ontario, Canada
  • Urquhart, Brad, Western University, London, Ontario, Canada
  • Lee, Ting, Western University, London, Ontario, Canada
  • McIntyre, Christopher W., Western University, London, Ontario, Canada
Background

Hemodialysis (HD) exerts significant hemodynamic effects on vulnerable vascular beds. The liver has preserved blood flow during dialysis due to its dual blood supply. Even so, its excretory function is lower, despite an increase in toxin-rich portal vein flow. Extracorporeal cooling has a protective effect on multiple organs during dialysis, but its effect on the liver is unknown. We used CT perfusion imaging to examine the effect of cooling on hepatic blood flow and detoxifying function during HD.

Methods

In this pilot randomized cross-over study, 16 HD patients underwent two HD study sessions – one at standard dialysis temperature (36.5 degrees Celsius), and one at cooler dialysis (35 degrees Celsius; order of the sessions was randomly allocated). Participants had dynamic contrast-enhanced CT studies of their liver using a 256-slice GE scanner pre (baseline), 3 hours into (peak hemodynamic stress), and post HD. Perfusion maps of total liver, hepatic arterial and portal venous blood flow were generated and analyzed by CT Perfusion (GE Healthcare). Furthermore, subjects had non- invasive pulse dye densitometry (Nihon Kohden) measurements of indocyanine green (ICG) clearance as a marker of liver excretory function and serial blood sampling to assess endotoxin levels.

Results

The cohort had an average age of 63years old (range 47-84 years), 37.5% were female and the average dialysis vintage was 66.5 months (range 9-305 months). An increase in portal vein blood flow at peak HD stress compared to baseline was seen in 62.5% (10/16) of subjects with standard HD (118.6±10.0%). Cooler HD prevented this perfusion change in the portal vein (95.7±12.6%, p=0.03). Total liver blood flow and hepatic arterial flow were not statistically different amongst standard vs. cooler HD treatments. Standard HD also resulted in a significant decrease in ICG clearance at peak stress relative to baseline (85.5±10.4%, p=0.02), which was absent in the cooler HD sessions (92.6±12.1%, p=0.25). Cooler HD also had a trend of increased clearance of uremic toxins: indoxyl sulfate, hippuric acid and phenyl sulfate.

Conclusion

In a subgroup of patients, standard HD causes significant increases in toxin-rich portal vein blood flow at peak hemodynamic stress, which can be mitigated by extracorporeal cooling. Cooler HD also preserves the liver detoxifying function, which usually decreases with standard treatment.