Online monitoring of cerebral hemodynamics during hemodialysis.
BACKGROUND
Several factors, including anemia, diabetes, and hypertension, potentially could disturb the cerebral autoregulation mechanism in hemodialysis (HD) patients. This study examined the effect of hemodynamic and rheological changes on mean cerebral blood flow (CBF) velocity (MV) during HD.


METHODS
Continuous online monitoring of MV and pulsatility index in the middle cerebral artery were performed in 18 HD patients by transcranial Doppler ultrasound during the entire HD period (range, 3 to 4 hours). In addition, blood pressure, hematocrit (Hct), and relative decrease in blood volume were continuously monitored. Blood samples were obtained at the beginning and end of HD to measure hemorheological variables.


RESULTS
After HD, Hct increased significantly from 33.6% +/- 5.9% to 41.4% +/- 5.7% (P < 0.001). Blood and plasma viscosity increased significantly from 3.33 +/- 0.77 to 4.36 +/- 1.3 mPa.s (P < 0.001) and from 1.35 +/- 0.29 to 1.54 +/- 0.38 mPa.s (P < 0.001), respectively. The change in MV (DeltaMV) was not significantly different from zero and correlated significantly with change in Hct. During HD, mean arterial pressure (MAP) in 15 patients changed within the normal range (group I), whereas 3 patients developed hypotension (group II) and their MAP decreased from 99 +/- 5 to 60 +/- 8 mm Hg (P < 0.05). In both groups, DeltaMV were not significant.


CONCLUSIONS
Results of this study suggest that CBF does not appear to be diminished significantly during HD.
Metry
George
G
Division of Nephrology, Beth Israel Medical Center, New York, NY, USA. gmetry@hotmail.com
Spittle
Margaret
M
Rahmati
Shahriar
S
Giller
Cole
C
Giller
Angela
A
Kaufman
Allen
A
Schneditz
Daniel
D
Manno
Edward
E
Brener
Zohar
Z
Boniece
Irene
I
Ronco
Federico
F
Ronco
Claudio
C
Levin
Nathan W
NW
D000368:Aged; D000369:Aged, 80 and over; D002540:Cerebral Cortex / Q000098:blood supply*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D018056:Hemorheology / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D009862:Online Systems; D012039:Regional Blood Flow / Q000502:physiology; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation / Q000379:methods