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Imai S, Ito K, Ookawara S, Kiryu S, Iguchi M, Sanayama H, Kakei M, Tabei K, Morishita Y. Does food ingestion during hemodialysis lead to change in hepatic oxygenation? Nefrologia 2023; 43:506-508. [PMID: 36402687 DOI: 10.1016/j.nefroe.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 06/16/2023] Open
Affiliation(s)
- Sojiro Imai
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Kiyonori Ito
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Satoshi Kiryu
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Miho Iguchi
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Hidenori Sanayama
- Division of Neurology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masafumi Kakei
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Kaoru Tabei
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Janssen BGH, Zhang YM, Kosik I, Akbari A, McIntyre CW. Intravital microscopic observation of the microvasculature during hemodialysis in healthy rats. Sci Rep 2022; 12:191. [PMID: 34996931 PMCID: PMC8741960 DOI: 10.1038/s41598-021-03681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
Hemodialysis (HD) provides life-saving treatment for kidney failure. Patient mortality is extremely high, with cardiovascular disease (CVD) being the leading cause of death. This results from both a high underlying burden of cardiovascular disease, as well as additional physiological stress from the HD procedure itself. Clinical observations indicate that HD is associated with microvascular dysfunction (MD), underlining the need for a fundamental pathophysiological assessment of the microcirculatory consequences of HD. We therefore successfully developed an experimental small animal model, that allows for a simultaneous real-time assessment of the microvasculature. Using in-house built ultra-low surface area dialyzers and miniaturized extracorporeal circuit, we successfully dialyzed male Wistar Kyoto rats and combined this with a simultaneous intravital microscopic observation of the EDL microvasculature. Our results show that even in healthy animals, a euvolemic HD procedure can induce a significant systemic hemodynamic disturbance and induce disruption of microvascular perfusion (as evidence by a reduction in the proportion of the observed microcirculation receiving blood flow). This study, using a new small animal hemodialysis model, has allowed direct demonstration that microvascular blood flow in tissue in skeletal muscle is acutely reduced during HD, potentially in concert with other microvascular beds. It shows that preclinical small animal models can be used to further investigate HD-induced ischemic organ injury and allow rapid throughput of putative interventions directed at reducing HD-induced multi-organ ischemic injury.
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Affiliation(s)
- B G H Janssen
- Department of Medical Biophysics, Western University, London, ON, Canada.
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada.
- Kidney Clinical Research Unit (KCRU), London Health Sciences Centre, 800 Commissioners Rd. East, London, ON, N6C 6B5, Canada.
| | - Y M Zhang
- Department of Medical Biophysics, Western University, London, ON, Canada
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada
- Trauma Research Centre, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
- Intensive Care Unit, Tianjin Nankai Hospital, Tianjin, 300100, People's Republic of China
| | - I Kosik
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada
- Imaging Program, Lawson Health Research Institute, St. Joseph's Health Care, London, ON, Canada
| | - A Akbari
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada
- Robarts Research Institute, Western University, London, ON, Canada
| | - C W McIntyre
- Department of Medical Biophysics, Western University, London, ON, Canada
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada
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Ueda Y, Ookawara S, Ito K, Sasabuchi Y, Hayasaka H, Kofuji M, Uchida T, Imai S, Kiryu S, Minato S, Miyazawa H, Sanayama H, Hirai K, Tabei K, Morishita Y. Association between hepatic oxygenation on near-infrared spectroscopy and clinical factors in patients undergoing hemodialysis. PLoS One 2021; 16:e0259064. [PMID: 34673824 PMCID: PMC8530328 DOI: 10.1371/journal.pone.0259064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
The hepato-splanchnic circulation directly influences oxygenation of the abdominal organs and plays an important role in compensating for the blood volume reduction that occurs in the central circulation during hemodialysis (HD) with ultrafiltration. However, the hepato-splanchnic circulation and oxygenation cannot be easily evaluated in the clinical setting of HD therapy. We included 185 HD patients and 15 healthy volunteers as the control group in this study. Before HD, hepatic regional oxygen saturation (rSO2), a marker of hepatic oxygenation reflecting the hepato-splanchnic circulation and oxygenation, was monitored using an INVOS 5100c oxygen saturation monitor. Hepatic rSO2 was significantly lower in patients undergoing HD than in healthy controls (56.4 ± 14.9% vs. 76.2 ± 9.6%, p < 0.001). Multivariable regression analysis showed that hepatic rSO2 was independently associated with body mass index (BMI; standardized coefficient: 0.294), hemoglobin (Hb) level (standardized coefficient: 0.294), a history of cardiovascular disease (standardized coefficient: -0.157), mean blood pressure (BP; standardized coefficient: 0.154), and serum albumin concentration (standardized coefficient: 0.150) in Model 1 via a simple linear regression analysis. In Model 2 using the colloid osmotic pressure (COP) in place of serum albumin concentration, the COP (standardized coefficient: 0.134) was also identified as affecting hepatic rSO2. Basal hepatic oxygenation before HD might be affected by BMI, Hb levels, a history of cardiovascular disease, mean BP, serum albumin concentration, and the COP. Further prospective studies are needed to clarify whether changes in these parameters, including during HD, affect the hepato-splanchnic circulation and oxygenation in HD patients.
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Affiliation(s)
- Yuichiro Ueda
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Kiyonori Ito
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Hideyuki Hayasaka
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaya Kofuji
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takayuki Uchida
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sojiro Imai
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Satoshi Kiryu
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Saori Minato
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Sanayama
- Division of Neurology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaoru Tabei
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Changes in tissue oxygenation in response to sudden intradialytic hypotension. J Artif Organs 2019; 23:187-190. [PMID: 31760517 DOI: 10.1007/s10047-019-01147-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
A 76-year-old woman on hemodialysis (HD) for diabetic nephropathy was admitted to our hospital with occasional intradialytic hypotension (IDH). We continuously monitored the regional oxygen saturation (rSO2) in the brain, liver, and lower limb muscle during HD. The time course of changes in rSO2 ratios in each region was evaluated throughout HD. The rSO2 ratio was defined as the ratio of rSO2 value at t (min) during HD to the rSO2 value before HD. During the early phase of HD, blood pressure (BP) gradually decreased and both hepatic and lower limb muscle rSO2 ratios decreased with changes in BP, whereas the cerebral rSO2 ratio was relatively maintained. At around 90 min after HD initiation, the BP decreased to 71/46 mmHg (mean BP, 54 mmHg) and the previously maintained cerebral rSO2 ratio also suddenly decreased. Soon after the onset of IDH, ultrafiltration was stopped, normal saline was infused, and intravenous noradrenaline infusion was started. After the BP recovered, cerebral and hepatic rSO2 ratios improved, but the lower limb muscle rSO2 ratio remained low. After restarting ultrafiltration, improvement in the lower limb muscle rSO2 ratio was delayed, although cerebral and hepatic oxygenation were maintained. This observation aids in our understanding of the effect of IDH on regional tissue oxygenation.
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