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Kidney Week

Abstract: TH-PO787

Cerebral Oxygenation Changes in Pediatric Chronic Hemodialysis

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Idrovo, Alexandra, Texas Children's Hospital-Feign Tower, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Texas Children's Hospital, Houston, Texas, United States
  • Geer, Jessica, Texas Children's Hospital, Houston, Texas, United States
  • Swartz, Sarah J., Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background

Intradialytic circulatory stress has been well described in adults as tissue ischemia to diverse organs (heart, gut and brain) during hemodialysis (HD). We aimed to determine if pediatric patients had intradialytic changes in cerebral oximetry (CEOx) by using near infrared spectroscopy (NIRS), a continuous, non-invasive method that uses infrared light to penetrate the skull and provides real time regional oxygen saturation (rSO2) from the frontal cortex. NIRS correlates well with more invasive measures of cerebral perfusion, doppler ultrasound and MRIs.

Methods

Prospective study in 14 patients <21 years old with more than 90 days on HD, on room air, without congenital heart disease. We used continuous NIRS and pulse oximetry (SpO2) monitoring, and obtained co-oximetry measured central venous oxygen saturation (SvO2) at the start, middle, and end of HD treatment. CEOx data was extracted at the exact times SvO2 was measured. Data collected over 2 HD treatments for each patient.

Results

Continuous monitor of spO2 showed no hypoxia during recorded HD treatments. Svo2 decreased from HD start 73(SD=7.7) to end of treatment 64.8(SD=9.1), mean difference 8.17(CI 2.3 to 14) p=0.01; CEOx also decreased from 74(SD=6.3) to 70(SD=5.7) mean difference 3.8(CI 1.5 to 6.2) p=0.002. For every 1 unit drop of SvO2 the CEOx decreased by 0.5 at the end of HD (β-1.0 (CI -2.6 to -0.4)).

Conclusion

Intradialytic CEOx and SvO2 falls significantly during HD in the absence of declining SpO2. These data suggest HD leads to cerebral dysoxia, though it is unclear whether the mechanism is related to decrease oxygen delivery, increased extraction or a combination of both at the tissue level. Future studies are needed to explore these physiological changes as well as the impact the cognitive functioning of children receiving chronic HD.