Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients

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I Ishida1, H Hirakata, H Sugimori

  • 1The Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka City, Japan.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|December 10, 1999
PubMed

Insights

Orthostatic hypotension significantly impacts cerebral blood flow in diabetic patients undergoing hemodialysis (HD). After HD, these patients experience greater reductions in blood flow velocity and blood pressure during orthostatic stress, increasing brain damage risk.

Area of Science:

  • Nephrology
  • Neurology
  • Cardiovascular Physiology

Background:

  • Orthostatic hypotension is a significant complication for patients with diabetes mellitus (DM) undergoing hemodialysis (HD).
  • Understanding the impact of orthostasis on cerebral circulation is crucial for managing these patients.
  • Previous research has not fully elucidated the cerebral hemodynamic response to orthostatic stress in diabetic HD patients.

Purpose of the Study:

  • To evaluate changes in cerebral blood flow velocity during orthostatic stress in diabetic patients undergoing hemodialysis.
  • To compare the cerebral hemodynamic response to orthostasis before and after bicarbonate hemodialysis between diabetic and non-diabetic HD patients.

Main Methods:

  • Transcranial Doppler sonography was used to measure mean blood flow velocity in the middle cerebral artery (VMCA).
  • Patients underwent a 60-degree head-up tilt for 5 minutes to induce orthostatic stress.
  • Cerebral blood flow velocity and mean blood pressure were assessed before and after bicarbonate hemodialysis in diabetic (DM) and non-diabetic (non-DM) HD patients.

Main Results:

  • Before HD, both DM and non-DM patients showed similar decreases in VMCA during tilt, despite greater mean blood pressure (MBP) reduction in DM patients.
  • After HD, MBP reduction during tilt was significantly greater in DM patients compared to before HD and compared to non-DM patients.
  • Post-HD, VMCA reduction during tilt was significantly more pronounced in DM patients than in non-DM patients and compared to their own pre-HD values, correlating positively with MBP changes.

Conclusions:

  • Cerebral blood flow is significantly affected by orthostatic stress in diabetic patients on hemodialysis, particularly after the procedure.
  • The marked reduction in cerebral blood flow velocity and blood pressure post-HD in diabetic patients suggests an increased risk of hemodynamically mediated brain damage.
  • Further investigation into strategies to mitigate orthostatic intolerance and protect cerebral circulation in this vulnerable population is warranted.

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