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Mutsuyoshi Y, Ito K, Ookawara S, Ueda Y, Shindo M, Hirata M, Nonaka H, Morino J, Kaneko S, Kitano T, Miyazawa H, Hirai K, Morishita Y. Effects to cerebral oxygenation by arteriovenous fistula creation in patients with chronic kidney disease. J Vasc Access 2024:11297298241257431. [PMID: 38825801 DOI: 10.1177/11297298241257431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Vascular access, including arteriovenous fistula (AVF), is essential in patients undergoing hemodialysis (HD). However, the presence of AVF is non-physiological in humans and could pose a burden to the systemic circulation or tissue microcirculation, potentially affecting tissue oxygenation, including in the brain. Recently, near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO2) as a marker of cerebral oxygenation in various settings, including in patients undergoing HD. Thus far, no studies have reported changes in cerebral rSO2 before and after AVF creation. This study aimed to monitor the differences in cerebral oxygenation before and after AVF creation and to clarify the clinical factors affecting the changes in cerebral rSO2. METHODS Forty-eight patients (34 men, 14 women) with chronic kidney disease (CKD) who were not undergoing dialysis and newly created AVF were recruited. Cerebral rSO2 values before and after AVF creation were evaluated using near-infrared spectroscopy (INVOS 5100c). RESULTS Cerebral rSO2 values were significantly changed from 60.3% ± 7.5% to 58.4% ± 6.8% before and after AVF creation in all patients (p < 0.001). Cerebral rSO2 were also lower in patients with diabetes mellitus (DM) than in those without DM (57.5 ± 7.1 vs 63.7 ± 6.5, p = 0.003) before surgery; however, no differences of changes in cerebral rSO2 were observed between the two groups after AVF creation. Additionally, multivariate regression analysis identified changes in HR (standardized coefficient: 0.436) as independent factors associated with changes in cerebral rSO2. CONCLUSION Surgically created AVF was associated with the deterioration of cerebral rSO2 in patients with CKD not undergoing dialysis. Notably, AVF could cause cerebral hypoxia, and thus further studies are needed to clarify the clinical factors influencing changes in cerebral oxygenation after AVF creation.
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Affiliation(s)
- Yuko Mutsuyoshi
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Momoko Hirata
- Division of Nephrology, Chofu Touzan Hospital, Tokyo, Japan
| | - Hiroaki Nonaka
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junki Morino
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shohei Kaneko
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taisuke Kitano
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Yagi Y, Kubo Y, Hoshino K, Okada K, Hotta K, Shinohara N, Morimoto Y. Differences of cerebral oxygen saturation in dialysis patients: a comparison of three principals of near infrared spectroscopy. J Anesth 2023; 37:861-867. [PMID: 37646882 DOI: 10.1007/s00540-023-03245-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE It has been reported that cerebral oxygen saturation (rSO2) measured by near infrared spectroscopy is low in dialysis patients. We compared the rSO2 values of dialysis patients before living donor kidney transplantation and their donors as controls by using three spectroscopes that utilize different principals, the INVOS 5100C (spatially resolved spectroscopy), FORE-SIGHT ELITE (modified Beer-Lambert law) and tNIRS-1 (time-resolved spectroscopy). METHODS Before induction of anesthesia, the sensors of one of the three spectroscopes were placed on the forehead and rSO2 values were recorded followed by the same measurement using the other two spectroscopes. The primary objective was to compare the rSO2 values of the dialysis patients and controls using the three spectroscopes by the unpaired t test. Then we compared the rSO2 values among the spectroscopes in both dialysis patients and controls by one-way ANOVA. Finally, we examined the relations between the rSO2 values and the physiological values by using the Pearson correlation coefficient. RESULTS Fifteen pairs of dialysis patients and controls were studied. With the INVOS 5100 C, the values of the dialysis patients (59.7 ± 9.7% (mean ± standard deviation) were 13% lower than those of the controls (73.3 ± 6.9%) (P < 0.01). With the tNIRS-1, the values were 57.8 ± 4.8% in the dialysis patients and 63.3 ± 3.5% in the controls (P < 0.01). Almost no differences were observed with the FORE-SIGHT ELITE (71.6 ± 4.9% [dialysis patients] vs. 70.8 ± 4.3% [Controls]) (P = 0.62). Among the spectroscopes, the values were significantly different in both dialysis patients and controls. For the INVOS 5100C and tNIRS-1, correlation coefficients between rSO2 values and blood Hb and serum Alb were more than 0.5. CONCLUSIONS The rSO2 values for comparisons between the dialysis patients and the controls were different according to differences of the principles of the near infrared spectroscopes. In the INVOS 5100C and tNIRS-1, rSO2 values may be related to blood Hb and serum Alb.
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Affiliation(s)
- Yasunori Yagi
- Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan
| | - Yasunori Kubo
- Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Hoshino
- Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazufumi Okada
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Morimoto
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
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Delrue C, De Bruyne S, Speeckaert MM. The Potential Use of Near- and Mid-Infrared Spectroscopy in Kidney Diseases. Int J Mol Sci 2023; 24:ijms24076740. [PMID: 37047712 PMCID: PMC10094824 DOI: 10.3390/ijms24076740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Traditional renal biomarkers such as serum creatinine and albuminuria/proteinuria are rather insensitive since they change later in the course of the disease. In order to determine the extent and type of kidney injury, as well as to administer the proper therapy and enhance patient management, new techniques for the detection of deterioration of the kidney function are urgently needed. Infrared spectroscopy is a label-free and non-destructive technique having the potential to be a vital tool for quick and inexpensive routine clinical diagnosis of kidney disorders. The aim of this review is to provide an overview of near- and mid-infrared spectroscopy applications in patients with acute kidney injury and chronic kidney disease (e.g., diabetic nephropathy and glomerulonephritis).
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Affiliation(s)
- Charlotte Delrue
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sander De Bruyne
- Department of Diagnostic Sciences, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
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Sugiyama T, Ito K, Ookawara S, Shimoyama H, Shindo M, Hirata M, Shimoyama H, Nakazato Y, Morishita Y. Effects of percutaneous transluminal angioplasty and associated factors in access hand oxygenation in patients undergoing hemodialysis. Sci Rep 2023; 13:2576. [PMID: 36781901 PMCID: PMC9925747 DOI: 10.1038/s41598-023-29879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
In hemodialysis (HD) patients with arteriovenous fistula (AVF), changes in systemic or peripheral tissue circulation occur non-physiologically via the presence of AVF; however, associations between blood flow and tissue oxygenation in the brain and access hand are uncertain. In this study, 85 HD patients with AVF were included and evaluated for changes in flow volume (FV) and regional oxygen saturation (rSO2) in the brain and hands with AVF before and after percutaneous transluminal angioplasty (PTA). Furthermore, we evaluated the factors that determine access hand rSO2 without stenosis after PTA. Brachial arterial FV increased after PTA (p < 0.001), and carotid FV decreased (p = 0.008). Access hand rSO2 significantly decreased after PTA (p < 0.001), but cerebral rSO2 did not significantly change (p = 0.317). In multivariable linear regression analysis of factors associated with access hand rSO2, serum creatinine (standardized coefficient: 0.296) and hemoglobin (standardized coefficient: 0.249) were extracted as independent factors for access hand rSO2. In conclusion, a decrease in access hand oxygenation and maintenance of cerebral oxygenation were observed throughout PTA. To maintain access hand oxygenation, it is important to adequately manage Hb level and maintain muscle mass, in addition to having an AVF with appropriate blood flow.
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Affiliation(s)
- Tomoko Sugiyama
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
- Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Hirofumi Shimoyama
- Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | | | - Momoko Hirata
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hiromi Shimoyama
- Division of Nephrology, Yuai Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Yuichi Nakazato
- Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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Cerebral oxygenation changes in response to post-hemodialysis standing. J Artif Organs 2022:10.1007/s10047-022-01343-2. [PMID: 35776247 DOI: 10.1007/s10047-022-01343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/05/2022] [Indexed: 10/17/2022]
Abstract
Few reports have examined the association between changes in cerebral oxygenation and clinical factors, including blood pressure (BP), upon standing after hemodialysis (HD). This study aimed to clarify the factors affecting the changes in cerebral regional oxygen saturation (rSO2) upon standing after HD and monitor the differences in cerebral rSO2 changes that occur upon standing after HD in patients with and without diabetes mellitus (DM). Changes in mean BP and cerebral rSO2 were tracked in 43 HD patients during 120 s of standing after HD using an INVOS 5100c oxygen saturation monitor. The post-HD cerebral rSO2 at rest was 55.8 ± 10.2%, while that at 120 s of standing decreased to 51.9 ± 9.6%; therefore, the percentage change in cerebral rSO2 at 120 s of standing was - 6.8 ± 6.4%, which was significantly lower than before HD (p < 0.001). This change was significantly correlated with the presence of DM, HD duration, mean BP at 120 s of standing, and percentage change in mean BP at 120 s of standing. A multivariable linear regression analysis showed that percentage change in cerebral rSO2 at 120 s of standing was independently associated with the percentage change in mean BP at 120 s of standing (standardized coefficient: 0.432; p = 0.004). Furthermore, there were significant decreases in percentage changes in cerebral rSO2 throughout the standing period in HD patients with versus without DM. Therefore, cerebral oxygenation deterioration upon standing after HD should receive attention, particularly in HD patients with DM.
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Ookawara S, Ito K, Sasabuchi Y, Miyahara M, Miyashita T, Takemi N, Nagamine C, Nakahara S, Horiuchi Y, Inose N, Shiina M, Murakoshi M, Sanayama H, Hirai K, Morishita Y. Cerebral oxygenation and body mass index association with cognitive function in chronic kidney disease patients without dialysis: a longitudinal study. Sci Rep 2022; 12:10809. [PMID: 35752646 PMCID: PMC9233691 DOI: 10.1038/s41598-022-15129-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/20/2022] [Indexed: 12/30/2022] Open
Abstract
In chronic kidney disease (CKD) patients, the prevalence of cognitive impairment increases with CKD progression; however, longitudinal changes in cognitive performance remain controversial. Few reports have examined the association of cerebral oxygenation with cognitive function in longitudinal studies. In this study, 68 CKD patients were included. Cerebral regional oxygen saturation (rSO2) was monitored. Cognitive function was evaluated using mini-mental state examination (MMSE) score. Clinical assessments were performed at study initiation and 1 year later. MMSE score was higher at second measurement than at study initiation (p = 0.022). Multivariable linear regression analysis showed that changes in MMSE were independently associated with changes in body mass index (BMI, standardized coefficient: 0.260) and cerebral rSO2 (standardized coefficient: 0.345). This was based on clinical factors with p < 0.05 (changes in BMI, cerebral rSO2, and serum albumin level) and the following confounding factors: changes in estimated glomerular filtration rate, hemoglobin level, proteinuria, salt and energy intake, age, presence of diabetes mellitus, history of comorbid cerebrovascular disease, and use of renin–angiotensin system blocker. Further studies with a larger sample size and longer observational period are needed to clarify whether maintaining BMI and cerebral oxygenation improve or prevent the deterioration of cognitive function.
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Affiliation(s)
- Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan. .,Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.,Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Mayako Miyahara
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomoka Miyashita
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nana Takemi
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Chieko Nagamine
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shinobu Nakahara
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Horiuchi
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nagisa Inose
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Michiko Shiina
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Miho Murakoshi
- Department of Nutrition, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Sanayama
- Division of Neurology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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