title: Intradialytic Hypoxemia in Chronic Hemodialysis Patients.
abstract: When kidney failure occurs, patients are at risk for fluid overload states, which can cause pulmonary edema, pleural effusions, and upper airway obstruction. Kidney disease is also associated with impaired respiratory function, as in central sleep apnea or chronic obstructive pulmonary disease. Hence, respiratory and renal diseases are frequently coexisting. Hypoxemia is the terminal pathway of a multitude of respiratory pathologies. The measurement of oxygen saturation (SO2) is a basic and commonly used tool in clinical practice. Both arterial oxygen saturation (SaO2) and central venous oxygen saturation (ScvO2) can be easily obtained in hemodialysis (HD) patients, SaO2 from an arteriovenous access and ScvO2 from a central catheter. Here, we give a brief overview of the anatomy and physiology of the respiratory system, and the different technologies that are currently available to measure oxygen status in dialysis patients. We then focus on literature regarding intradialytic SaO2 and ScvO2. Lastly, we present clinical vignettes of intradialytic drops in SaO2 and ScvO2 in association with different symptoms and clinical scenarios with an emphasis on the pathophysiology of these cases. Given the fact that in the general population hypoxemia is associated with adverse outcomes, including increased mortality, cardiac arrhythmias and cardiovascular events, we posit that intradialytic SO2 may serve as a potential marker to identify HD patients at increased risk for morbidity and mortality.
authors.affiliation: Renal Research Institute, New York, NY, USA.
authors.forename: Israel
authors.initials: I
authors.lastname: Campos
authors.forename: Lili
authors.initials: L
authors.lastname: Chan
authors.forename: Hanjie
authors.initials: H
authors.lastname: Zhang
authors.forename: Sheila
authors.initials: S
authors.lastname: Deziel
authors.forename: Cheryl
authors.initials: C
authors.lastname: Vaughn
authors.forename: Anna
authors.initials: A
authors.lastname: Meyring-Wösten
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
mesh_terms: D015415:Biomarkers / Q000097:blood; D059347:Cardio-Renal Syndrome / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002405:Catheterization, Central Venous; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010100:Oxygen / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010100:Oxygen