Wesley T Richerson1, Brian D Schmit2, Dawn F Wolfgram3. 1. Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin wesley.richerson@marquette.edu. 2. Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Department of Medicine, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.
Abstract
BACKGROUND: Patients with kidney failure treated with hemodialysis (HD) may be at risk for cerebral hypoperfusion due to HD-induced BP decline in the setting of impaired cerebral autoregulation. Cerebrovascular reactivity (CVR), the cerebrovascular response to vasoactive stimuli, may be a useful indicator of cerebral autoregulation in the HD population and identify those at risk for cerebral hypoperfusion. We hypothesize that CVR combined with intradialytic BP changes will be associated with declines in cerebral oxygenation saturation (ScO2) during HD. METHODS: Participants completed the MRI scans on a non-HD day and cerebral oximetry during HD. We measured CVR with resting-state fMRI (rs-fMRI) without a gas challenge and ScO2 saturation with near-infrared spectroscopy. Regression analysis was used to examine the relationship between intradialytic cerebral oxygen desaturation, intradialytic BP, and CVR in different gray matter regions. RESULTS: Twenty-six patients on HD had complete data for analysis. Sixteen patients were men, 18 had diabetes, and 20 had hypertension. Mean±SD age was 65.3±7.2 years, and mean±SD duration on HD was 11.5±9.4 months. CVR in the anterior cingulate gyrus (ACG; P=0.03, r2 =0.19) and insular cortex (IC; P=0.03, r2 =0.19) regions negatively correlated with decline in intradialytic ScO2. Model prediction of intradialytic ScO2 improved when including intradialytic BP change and ultrafiltration rate to the ACG rsCVR (P<0.01, r2 =0.48) and IC rsCVR (P=0.02, r2 =0.35) models, respectively. CONCLUSIONS: We found significant relationships between regional rsCVR measured in the brain and decline in intradialytic ScO2. Our results warrant further exploration of using CVR in determining a patient's risk of cerebral ischemic injury during HD.
BACKGROUND: Patients with kidney failure treated with hemodialysis (HD) may be at risk for cerebral hypoperfusion due to HD-induced BP decline in the setting of impaired cerebral autoregulation. Cerebrovascular reactivity (CVR), the cerebrovascular response to vasoactive stimuli, may be a useful indicator of cerebral autoregulation in the HD population and identify those at risk for cerebral hypoperfusion. We hypothesize that CVR combined with intradialytic BP changes will be associated with declines in cerebral oxygenation saturation (ScO2) during HD. METHODS: Participants completed the MRI scans on a non-HD day and cerebral oximetry during HD. We measured CVR with resting-state fMRI (rs-fMRI) without a gas challenge and ScO2 saturation with near-infrared spectroscopy. Regression analysis was used to examine the relationship between intradialytic cerebral oxygen desaturation, intradialytic BP, and CVR in different gray matter regions. RESULTS: Twenty-six patients on HD had complete data for analysis. Sixteen patients were men, 18 had diabetes, and 20 had hypertension. Mean±SD age was 65.3±7.2 years, and mean±SD duration on HD was 11.5±9.4 months. CVR in the anterior cingulate gyrus (ACG; P=0.03, r2 =0.19) and insular cortex (IC; P=0.03, r2 =0.19) regions negatively correlated with decline in intradialytic ScO2. Model prediction of intradialytic ScO2 improved when including intradialytic BP change and ultrafiltration rate to the ACG rsCVR (P<0.01, r2 =0.48) and IC rsCVR (P=0.02, r2 =0.35) models, respectively. CONCLUSIONS: We found significant relationships between regional rsCVR measured in the brain and decline in intradialytic ScO2. Our results warrant further exploration of using CVR in determining a patient's risk of cerebral ischemic injury during HD.
Authors: Jorn Fierstra; Julien Poublanc; Jay Shou Han; Frank Silver; Michael Tymianski; Adrian Phillip Crawley; Joseph Arnold Fisher; David John Mikulis Journal: J Neurol Neurosurg Psychiatry Date: 2010-03 Impact factor: 10.154
Authors: Robert K Heaton; Natacha Akshoomoff; David Tulsky; Dan Mungas; Sandra Weintraub; Sureyya Dikmen; Jennifer Beaumont; Kaitlin B Casaletto; Kevin Conway; Jerry Slotkin; Richard Gershon Journal: J Int Neuropsychol Soc Date: 2014-06-24 Impact factor: 2.892
Authors: Thaddeus J Haight; R Nick Bryan; Guray Erus; Christos Davatzikos; David R Jacobs; Mark D'Esposito; Cora E Lewis; Lenore J Launer Journal: Neuroimage Date: 2015-04-24 Impact factor: 7.400