Hemodialysis Induces Decline in Cerebral Blood Flow in Elderly

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Global CBF declined significantly by 10% from before the start to the end of hemodialysis.
Global CBF declined significantly by 10% from before the start to the end of hemodialysis.

(HealthDay News) -- In elderly patients, conventional hemodialysis induces a reduction in cerebral blood flow (CBF), according to a study published online in the Journal of the American Society of Nephrology.

Harmke A. Polinder-Bos, MD, from the University of Groningen in the Netherlands, and colleagues examined the acute effect of conventional hemodialysis on CBF. Three [15O]H2O positron emission tomography-computed tomography scans were performed before, early after the start of, and at the end of hemodialysis. Global and regional changes in CBF were measured in 12 patients aged ≥65 years with a median dialysis vintage of 46 months.

The researchers observed a decrease in mean arterial blood pressure from 101 ± 11 mm Hg before hemodialysis to 93 ± 17 mm Hg at the end of hemodialysis. Global CBF decreased significantly by 10 ± 15%, from a mean of 34.5 to 30.5ml/100 g per minute from before the start to the end of hemodialysis. In one patient the decline in CBF (20%) was symptomatic. In all volumes of interest there were declines in regional CBF, including the frontal, parietal, temporal, and occipital lobes, the cerebellum, and thalamus. There was a correlation for higher tympanic temperature, ultrafiltration volume, ultrafiltration rate, and pH with lower CBF.

"Conventional hemodialysis induces a significant reduction in global and regional CBF in elderly patients," the authors write. "Repetitive intradialytic decreases in CBF may be one mechanism by which hemodialysis induces cerebral ischemic injury."

References

Polinder-Bos HA, Vállez García D, Kuipers J, et al. Hemodialysis Induces an Acute Decline in Cerebral Blood Flow in Elderly Patients. JASN doi: 10.1681/ASN.2017101088 [Published online March 1, 2018]
Wolfgram DF. Filtering the Evidence: Is There a Cognitive Cost of Hemodialysis? JASN [Published online March 1, 2018],

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