Raanan Marants1,2, Elena Qirjazi3, Claire J Grant4, Ting-Yim Lee1,2,4, Christopher W McIntyre5,3,4,6. 1. Department of Medical Biophysics, Western University, London, Canada. 2. Robarts Research Institute, Western University, London, Canada. 3. The Lilibeth Caberto Kidney Clinical Research Unit and. 4. Lawson Health Research Institute, London Health Sciences Centre, London, Canada. 5. Department of Medical Biophysics, Western University, London, Canada; cmcint48@uwo.ca. 6. Division of Nephrology, London Health Sciences Centre, London, Canada; and.
Abstract
BACKGROUND: Residual renal function (RRF) confers survival in patients with ESRD but declines after initiating hemodialysis. Previous research shows that dialysate cooling reduces hemodialysis-induced circulatory stress and protects the brain and heart from ischemic injury. Whether hemodialysis-induced circulatory stress affects renal perfusion, and if it can be ameliorated with dialysate cooling to potentially reduce RRF loss, is unknown. METHODS: We used renal computed tomography perfusion imaging to scan 29 patients undergoing continuous dialysis under standard (36.5°C dialysate temperature) conditions; we also scanned another 15 patients under both standard and cooled (35.0°C) conditions. Imaging was performed immediately before, 3 hours into, and 15 minutes after hemodialysis sessions. We used perfusion maps to quantify renal perfusion. To provide a reference to another organ vulnerable to hemodialysis-induced ischemic injury, we also used echocardiography to assess intradialytic myocardial stunning. RESULTS: During standard hemodialysis, renal perfusion decreased 18.4% (P<0.005) and correlated with myocardial injury (r=-0.33; P<0.05). During sessions with dialysis cooling, patients experienced a 10.6% decrease in perfusion (not significantly different from the decline with standard hemodialysis), and ten of the 15 patients showed improved or no effect on myocardial stunning. CONCLUSIONS: This study shows an acute decrease in renal perfusion during hemodialysis, a first step toward pathophysiologic characterization of hemodialysis-mediated RRF decline. Dialysate cooling ameliorated this decline but this effect did not reach statistical significance. Further study is needed to explore the potential of dialysate cooling as a therapeutic approach to slow RRF decline.
BACKGROUND: Residual renal function (RRF) confers survival in patients with ESRD but declines after initiating hemodialysis. Previous research shows that dialysate cooling reduces hemodialysis-induced circulatory stress and protects the brain and heart from ischemic injury. Whether hemodialysis-induced circulatory stress affects renal perfusion, and if it can be ameliorated with dialysate cooling to potentially reduce RRF loss, is unknown. METHODS: We used renal computed tomography perfusion imaging to scan 29 patients undergoing continuous dialysis under standard (36.5°C dialysate temperature) conditions; we also scanned another 15 patients under both standard and cooled (35.0°C) conditions. Imaging was performed immediately before, 3 hours into, and 15 minutes after hemodialysis sessions. We used perfusion maps to quantify renal perfusion. To provide a reference to another organ vulnerable to hemodialysis-induced ischemic injury, we also used echocardiography to assess intradialytic myocardial stunning. RESULTS: During standard hemodialysis, renal perfusion decreased 18.4% (P<0.005) and correlated with myocardial injury (r=-0.33; P<0.05). During sessions with dialysis cooling, patients experienced a 10.6% decrease in perfusion (not significantly different from the decline with standard hemodialysis), and ten of the 15 patients showed improved or no effect on myocardial stunning. CONCLUSIONS: This study shows an acute decrease in renal perfusion during hemodialysis, a first step toward pathophysiologic characterization of hemodialysis-mediated RRF decline. Dialysate cooling ameliorated this decline but this effect did not reach statistical significance. Further study is needed to explore the potential of dialysate cooling as a therapeutic approach to slow RRF decline.
Authors: Maarten A M Jansen; Augustinus A M Hart; Johanna C Korevaar; Friedo W Dekker; Elisabeth W Boeschoten; Raymond T Krediet Journal: Kidney Int Date: 2002-09 Impact factor: 10.612
Authors: Louise M Moist; Friedrich K Port; Sean M Orzol; Eric W Young; Truls Ostbye; Robert A Wolfe; Tempie Hulbert-Shearon; Camille A Jones; Wendy E Bloembergen Journal: J Am Soc Nephrol Date: 2000-03 Impact factor: 10.121
Authors: Harmke A Polinder-Bos; David Vállez García; Johanna Kuipers; Jan Willem J Elting; Marcel J H Aries; Wim P Krijnen; Henk Groen; Antoon T M Willemsen; Peter J van Laar; Fijanne Strijkert; Gert Luurtsema; Riemer H J A Slart; Ralf Westerhuis; Ron T Gansevoort; Carlo A J M Gaillard; Casper F M Franssen Journal: J Am Soc Nephrol Date: 2018-03-01 Impact factor: 10.121
Authors: Ilan S Wittstein; David R Thiemann; Joao A C Lima; Kenneth L Baughman; Steven P Schulman; Gary Gerstenblith; Katherine C Wu; Jeffrey J Rade; Trinity J Bivalacqua; Hunter C Champion Journal: N Engl J Med Date: 2005-02-10 Impact factor: 91.245
Authors: Keith A Gillis; Christie McComb; Rajan K Patel; Kathryn K Stevens; Markus P Schneider; Aleksandra Radjenovic; Scott T W Morris; Giles H Roditi; Christian Delles; Patrick B Mark Journal: Nephron Date: 2016-07-01 Impact factor: 2.847
Authors: Bernard Canaud; Stefano Stuard; Frank Laukhuf; Grace Yan; Maria Ines Gomez Canabal; Paik Seong Lim; Michael A Kraus Journal: Clin Kidney J Date: 2021-12-27
Authors: Raanan Marants; Elena Qirjazi; Ka-Bik Lai; Cheuk-Chun Szeto; Philip K T Li; Fiona Li; Ting-Yim Lee; Christopher W McIntyre Journal: Kidney Int Rep Date: 2021-02-09
Authors: Jennifer E Flythe; Tara I Chang; Martin P Gallagher; Elizabeth Lindley; Magdalena Madero; Pantelis A Sarafidis; Mark L Unruh; Angela Yee-Moon Wang; Daniel E Weiner; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Kevan R Polkinghorne Journal: Kidney Int Date: 2020-03-08 Impact factor: 10.612
Authors: Paul A Rootjes; Camiel L M de Roij van Zuijdewijn; Muriel P C Grooteman; Michiel L Bots; Bernard Canaud; Peter J Blankestijn; Frans J van Ittersum; Francisco Maduell; Marion Morena; Sanne A E Peters; Andrew Davenport; Robin W M Vernooij; Menso J Nubé Journal: Kidney Int Rep Date: 2020-01-31
Authors: Jennifer E Flythe; Matthew J Tugman; Julia H Narendra; Magdalene M Assimon; Quefeng Li; Yueting Wang; Steven M Brunelli; Alan L Hinderliter Journal: J Nephrol Date: 2020-09-25 Impact factor: 3.902