Risk factors for intradialytic decline in cerebral perfusion and impaired cerebral autoregulation in adults on hemodialysis.
Risk factors for intradialytic decline in cerebral perfusion and impaired cerebral autoregulation in adults on hemodialysis.
复制标题
DOI：
10.1111/hdi.12974
复制
发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
血液透析（HD）患者的脑成像显示其脑缺血病理负担很重。这些缺血型病变可能是由于 HD 期间常见的血压 (BP) 波动期间可能发生的脑灌注不足所致。我们评估了 HD 期间脑灌注的变化并测量了脑自动调节指数（CA 指数），以确定透析期间脑灌注下降和脑自动调节受损的潜在危险因素。在这项横断面研究中，我们纳入了接受传统中心 HD 治疗的 50 岁或以上的 HD 患者。我们使用脑血氧饱和度测量HD期间的脑灌注，并计算HD期间脑灌注与血压之间的相关性作为CA的指标。我们测量了透析中脑灌注下降的潜在危险因素与 CA 指数之间的关联。我们的分析中包括 32 名参与者和 118 场高清会议。 HD 期间脑氧饱和度的平均±SD 下降为 6.5±2.9%，相对于基线值下降 9.2±4.4%。 HD 期间收缩压 (SBP) 下降幅度更大，与脑氧饱和度下降相关，p=0.02。 37.3% 的 HD 会话中 CA 指数受损。患有糖尿病且 HD 期间 SBP 下降 > 20 mmHg 与 CA 指数增加（更差）相关，糖尿病患者 CA 指数增加 0.24 95% CI [0.06,0.41]，HD 期间 SBP 下降 > 20 mmHg 则增加 0.43 95% CI [0.27,0.56]。 HD 期间脑灌注会下降，并与全身血压的变化相关。这可能是由于 HD 患者的大脑自动调节功能受损所致。 CA 指数恶化的危险因素包括糖尿病和 HD 期间收缩压下降 >20mmHg。这项研究强调了 HD 患者透析期间脑灌注下降和脑自动调节受损的风险。
Hemodialysis (HD) patients have significant burden of cerebral ischemic pathology noted on brain imaging. These ischemic type lesions maybe due to cerebral hypoperfusion that may be occurring during blood pressure (BP) fluctuations commonly noted during HD sessions. We evaluated changes in cerebral perfusion and measured an index of cerebral autoregulation (CA index) during HD to identify potential risk factors for intradialytic decline in cerebral perfusion and impaired cerebral autoregulation. In this cross-sectional study we included HD patients age 50 years or older receiving conventional in-center HD. We measured cerebral perfusion during HD, using cerebral oximetry, and calculated the correlation between cerebral perfusion and BP during HD as an index of CA. We measured the association between potential risk factors for intradialytic decline in cerebral perfusion and CA index. We included 32 participants and 118 HD sessions in our analysis. The mean ±SD decline in cerebral oxygen saturation during HD was 6.5±2.9% with a relative decline from baseline values of 9.2±4.4%. Greater drop in systolic BP (SBP) during HD was associated with decline in cerebral oxygen saturation, p=0.02. Impaired CA index was noted in 37.3% of HD sessions. Having diabetes and > 20mmHg drop in SBP during HD were associated with increased (worse) CA index with an increase of 0.24 95%CI [0.06,0.41] for diabetes and increase of 0.43 95%CI [0.27,0.56] for a > 20mmHg drop in SBP during HD. Cerebral perfusion can decline during HD and is associated with changes in systemic BP. This may be due to impaired cerebral autoregulation in HD patients. Risk factors for worse CA index include diabetes and >20mmHg drop in SBP during HD. This study highlights the risk of intradialytic decline in cerebral perfusion and impaired cerebral autoregulation in HD patients.
登录
查看更多内容
影响因子：
14.5
作者：
LEENDERS, KL;PERANI, D;JONES, T
通讯作者：
JONES, T
DOI：
10.1053/j.ajkd.2012.08.035
发表时间：
2013-02
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Drew DA;Bhadelia R;Tighiouart H;Novak V;Scott TM;Lou KV;Shaffi K;Weiner DE;Sarnak MJ
通讯作者：
Sarnak MJ
影响因子：
2.5
作者：
Kim YS;Seifert T;Brassard P;Rasmussen P;Vaag A;Nielsen HB;Secher NH;van Lieshout JJ
通讯作者：
van Lieshout JJ
影响因子：
8.3
作者：
Al-Rawi, PG;Smielewski, P;Kirkpatrick, PJ
通讯作者：
Kirkpatrick, PJ
影响因子：
9.8
作者：
Murkin, J M;Arango, M
通讯作者：
Arango, M