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Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs
Dec, 2019;22 (4): 316-323.

Differences in cerebral and hepatic oxygenation in response to intradialytic blood transfusion in patients undergoing hemodialysis.

Saori Minato, Susumu Ookawara, Kiyonori Ito, Haruhisa Miyazawa, Hideyuki Hayasaka, Masaya Kofuji, Takayuki Uchida, Junki Morino, Shohei Kaneko, Katsunori Yanai, Yuko Mutsuyoshi, Momoko Matsuyama, Hiroki Ishii, Mitsutoshi Shindo, Taisuke Kitano, Akinori Aomatsu, Yuichiro Ueda, Keiji Hirai, Taro Hoshino, Yoshiyuki Morishita
Author Information
  1. Saori Minato: 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. saorim0404@gmail.com.
  2. 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. su-ooka@hb.tp1.jp. ORCID
  3. 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.
  4. Haruhisa Miyazawa: 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.
  5. Hideyuki Hayasaka: Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
  6. Masaya Kofuji: Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
  7. Takayuki Uchida: Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
  8. Junki Morino: 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.
  9. Shohei Kaneko: 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.
  10. Katsunori Yanai: 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.
  11. Yuko Mutsuyoshi: 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.
  12. Momoko Matsuyama: 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.
  13. Hiroki Ishii: 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.
  14. Mitsutoshi Shindo: 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.
  15. Taisuke Kitano: 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.
  16. Akinori Aomatsu: 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.
  17. Yuichiro Ueda: 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.
  18. 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.
  19. Taro Hoshino: 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.
  20. 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.
PMID: 31342286 DOI: 10.1007/s10047-019-01118-2

Abstract

Hemodialysis (HD) patients frequently experience severe anemia, requiring intradialytic blood transfusion. Severe anemia leads to deterioration of systemic tissue oxygenation. However, few reports have examined the effect of intradialytic blood transfusion on tissue oxygenation changes. This study aimed to (i) monitor the differences in tissue oxygenation in the brain and liver during intradialytic blood transfusion, and (ii) elucidate the clinical factors affecting cerebral and hepatic oxygenation. Thirty-eight HD patients with severe anemia requiring intradialytic blood transfusion were included (27 men, 11 women; mean age, 70.2 ± 1.6 years). Cerebral and hepatic regional oxygen saturation (rSO) values were monitored using near-infrared spectroscopy (INVOS 5100c oxygen saturation monitor). Cerebral and hepatic rSO were significantly higher after than before blood transfusion (p < 0.001, both). Furthermore, hepatic rSO was significantly higher than cerebral rSO after transfusion (p = 0.004). In multivariable linear regression analysis, cerebral rSO changes were independently associated with the natural logarithm of hemoglobin (Hb) ratio (Hb after/before transfusion) (standardized coefficient: 0.367, p = 0.023), whereas hepatic rSO changes were independently associated with the natural logarithm of [Hb ratio/colloid osmotic pressure ratio (colloid osmotic pressure after/before transfusion)] (standardized coefficient: 0.378, p = 0.019). In conclusion, throughout intradialytic blood transfusion, brain and liver tissue oxygenation improved. Hepatic rSO was significantly higher than cerebral rSO at the end of HD. Furthermore, cerebral oxygenation changes were associated with only transfusion-induced Hb increase, whereas hepatic oxygenation changes were associated with both transfusion-induced Hb increase (positive changes) and ultrafiltration-induced colloid osmotic pressure increase (negative changes).

Keywords

Blood transfusion Brain Hemodialysis Liver Oxygenation

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Grants

  1. JKFB17-4/Kidney Foundation, Japan

MeSH Term

Aged
Anemia
Blood Transfusion
Brain
Female
Hemoglobins
Humans
Kidney Failure, Chronic
Liver
Male
Monitoring, Physiologic
Oxygen
Oxygen Consumption
Renal Dialysis
Spectroscopy, Near-Infrared

Chemicals

Hemoglobins
Oxygen
Journal Article Observational Study

Word Cloud

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