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Acute decrease in renal microvascular PO2 during acute normovolemic hemodilution.

Tanja Johannes1, Egbert G Mik, Boris Nohé

  • 1Dept. of Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. T.Johannes@amc.uva.nl

American Journal of Physiology. Renal Physiology
|November 2, 2006
PubMed
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Acute normovolemic hemodilution (ANH) critically impairs renal oxygen supply early on. Reduced hematocrit in ANH leads to decreased renal oxygen delivery and increased consumption, risking kidney function.

Area of Science:

  • Physiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Organ systems exhibit varied tolerance to reduced oxygen delivery, such as during hemodilution.
  • The kidney, receiving 25% of cardiac output, normally has oxygen delivery exceeding demand.
  • Understanding renal oxygenation during hemodilution is crucial for managing organ function.

Purpose of the Study:

  • To investigate the impact of acute normovolemic hemodilution (ANH) on renal regional and microvascular oxygenation in a rat model.
  • To determine the relationship between hematocrit, renal oxygen delivery, and oxygen consumption during ANH.
  • To assess the clinical relevance of altered renal oxygenation in the context of surgical hemodilution.

Main Methods:

  • Utilized a rat model of ANH with progressive hematocrit reduction (25%, 15%, 10%, <10%).

Related Experiment Videos

  • Monitored systemic and renal hemodynamic and oxygenation parameters.
  • Measured renal cortical and outer medullary microvascular PO(2) and renal venous PO(2) using oxygen-dependent quenching of phosphorescence.

    • Main Results:

    • Despite increased renal blood flow, microvascular PO(2) in renal cortex and outer medulla decreased immediately during ANH.
    • Renal oxygen consumption became dependent on oxygen delivery early in ANH.
    • A significant correlation between microvascular PO(2) and oxygen consumption, and a PO(2) gap were observed as hematocrit decreased.

    Conclusions:

    • Renal oxygen supply becomes critical early in ANH due to increased consumption, decreased delivery, and intrarenal shunting.
    • These findings highlight the risk of postoperative renal dysfunction associated with surgical hemodilution.
    • The study underscores the sensitivity of renal oxygenation to changes in hematocrit during hemodilution.