Effects to cerebral oxygenation by arteriovenous fistula creation in patients with chronic kidney disease

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.

Keywords

Cerebral oxygenation arteriovenous fistula hemodialysis near-infrared spectroscopy chronic kidney disease cerebral hypoxia

Get full access to this article

View all access options for this article.

References

Kukita

Ohira

Amano

, et al 2011 update Japanese Society for Dialysis Therapy Guidelines of vascular access construction and repair for chronic hemodialysis. Ther Apher Dial 2015; 19: 1–39.

Savage

Ferro

Sessano

, et al The impact of arteriovenous fistula formation on central hemodynamic pressures in chronic renal failure patients: a prospective study. Am J Kidney Dis 2002; 40: 753–759.

Bos

Zietse

Wesseling

, et al Effects of arteriovenous fistulas on cardiac oxygen supply and demand. Kidney Int 1999; 55: 2049–2053.

Ghoshal

Freedman

BI.

Mechanisms of stroke in patients with chronic kidney disease. Am J Nephrol 2019; 50: 229–239.

Brady

Joshi

Zweifel

, et al Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke 2010; 41: 1951–1956.

Alderliesten

De Vis

Lemmers

PMA

, et al Simultaneous quantitative assessment of cerebral physiology using respiratory-calibrated MRI and near-infrared spectroscopy in healthy adults. Neuroimage 2014; 85: 255–263.

Ito

Ookawara

Ueda

, et al Factors affecting cerebral oxygenation in hemodialysis patients: cerebral oxygenation associates with pH, hemodialysis duration, serum albumin concentration, and diabetes mellitus. PLoS One 2015; 10: e0117474.

Ookawara

Ito

Sasabuchi

, et al Association between cerebral oxygenation, as evaluated with near-infrared spectroscopy, and cognitive function in patients undergoing hemodialysis. Nephron 2021; 145: 171–178.

Tobias

JD.

Cerebral oxygenation monitoring: near-infrared spectroscopy. Expert Rev Med Dev 2006; 3: 235–243.

10.

Ferrari

Mottola

Quaresima

Principles, techniques, and limitations of near infrared spectroscopy. Can J Appl Physiol 2004; 29: 463–487.

11.

Lemmers

PMA

Toet

van Bel

. Impact of patient ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants. Pediatrics 2008; 121: 142–147.

12.

Hyttel-Sorensen

Sorensen

Riera

, et al Tissue oximetry: a comparison of mean values of regional tissue saturation, reproducibility and dynamic range of four NIRS-instruments on the human forearm. Biomed Opt Express 2011; 2: 3047–3057.

13.

Scmitz

Pichler

Schwaberger

, et al Feasibility of long-term cerebral and peripheral regional tissue oxygen saturation measurements. Physiol Meas 2014; 35: 1349–1355.

14.

Ookawara

Ito

Sasabuchi

, et al Association of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients. PLoS One 2020; 15: e0236720.

15.

Ortega-Loubon

Fernandez-Molina

Fierro

, et al Postoperative kidney oxygen saturation as a novel marker for acute kidney injury after adult cardiac surgery. J Thorac Cardiovasc Sug 2019; 157: 2340–2351.

16.

Hilly

Pailleret

Fromentin

, et al Use of near-infrared spectroscopy in predicting response to intravenous fluid load in anaesthetized infants. Anaesth Crit Care Pain Med 2015; 34: 265–270.

17.

Ito

Nishiyama

Callaway

, et al Noninvasive regional cerebral oxygen saturation for neurological prognostication of patients with out-of-hospital cardiac arrest: a prospective multicenter observational study. Resuscitation 2014; 85: 778–784.

18.

Polinder-Bos

Elting

JWJ

Aries

, et al Changes in cerebral oxygenation and cerebral blood flow during hemodialysis – a simultaneous near-infrared spectroscopy and positron emission tomography study. J Cereb Blood Flow Metab 2020; 40: 328–340.

19.

Kovarova

Valerianova

Kmentova

, et al Low cerebral oxygenation is associated with cognitive impairment in chronic hemodialysis patients. Nephron 2018; 139: 113–119.

20.

Olczyk

Jerzak

Letachowicz

, et al The influence of healthy habits on cognitive functions in a group of hemodialysis patients. J Clin Med 2023; 12: 2042.

21.

Etgen

Chonchol

Förstl

, et al Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol 2012; 35: 474–482.

22.

Iwashima

Horio

Takami

, et al Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis 2002; 40: 974–982.

23.

Malik

Valerianova

Tuka

, et al The effect of high-flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation. ESC Heart Fail 2021; 8: 2165–2171.

24.

Kovarova

Valerianova

Michna

, et al Short-term manual compression of hemodialysis fistula leads to a rise in cerebral oxygenation. J Vasc Access 2021; 22: 90–93.

25.

Valerianova

Mlcek

Kittnar

, et al A large arteriovenous fistula steals a considerable part of systemic blood flow during veno-arterial extracorporeal circulation support in a porcine model. Front Physiol 2023; 14: 1109524.

26.

MacEwen

Sutherland

Daly

, et al Relationship between hypotension and cerebral ischemia during hemodialysis. J Am Soc Nephrol 2017; 28: 2511–2520.

27.

Sugiyama

Ito

Ookawara

, et al Effect of percutaneous transluminal angioplasty and associated factors in access hand oxygenation in patients undergoing hemodialysis. Sci Rep 2023; 13: 2576.

28.

Imai

Ookawara

Ito

, et al Cerebral oxygenation changes in response to post-hemodialysis standing. J Artif Organs 2023; 26: 127–133.

29.

Laranjinha

Matias

Oliveira

, et al The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: results of a pilot study. J Vasc Access 2019; 20: 482–487.

30.

Malovrh

Native arteriovenous fistula: preoperative evaluation. Am J Kidney Dis 2002; 39: 1218–1225.

31.

Paquet

Deschamps

Denaut

, et al Baseline regional cerebral oxygen saturation correlates with left ventricular systolic and diastolic function. J Cardiothorac Vasc Anesth 2008; 22: 840–846.