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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Association between intradialytic central venous oxygen saturation and ultrafiltration volume in chronic hemodialysis
Hanjie Zhang1, Lili Chan2, Anna Meyring-Wösten1
1Renal Research Institute, New York, NY, USA.
Insights
High ultrafiltration volumes (UFVs) in hemodialysis patients are linked to decreased cardiac perfusion, indicated by a drop in central venous oxygen saturation (ScvO2). This suggests fluid-dependent cardiac function during dialysis.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Cardiovascular disease is a major concern for hemodialysis (HD) patients.
- High ultrafiltration volumes (UFVs) may impair cardiac function by reducing tissue perfusion.
- The relationship between central venous oxygen saturation (ScvO2) and UFVs in HD patients is not well understood.
Purpose of the Study:
- To investigate the association between intradialytic changes in ScvO2 and UFVs in maintenance HD patients.
- To determine if ScvO2 trends during dialysis correlate with the volume of fluid removed.
Main Methods:
- A retrospective cohort study of 6042 dialysis sessions in 232 maintenance HD patients.
- Central venous oxygen saturation (ScvO2) was monitored using the Critline device.
- Linear mixed effects models were used to analyze the relationship between ScvO2 trends and UFVs corrected for body weight (cUFV).
Main Results:
- ScvO2 decreased during approximately 62.4% of dialysis treatments.
- Nearly 80% of patients exhibited an inverse relationship between cUFV and ScvO2 trend.
- Higher cUFV was associated with a more pronounced decline in ScvO2 during dialysis.
Conclusions:
- Increased UFVs are generally associated with steeper intradialytic drops in ScvO2 among HD patients.
- This finding suggests that cardiac function in many HD patients may be fluid-dependent during dialysis.
- Further research involving direct hemodynamic measurements is recommended to validate these findings.
Background:
Cardiac disease is highly prevalent in hemodialysis (HD) patients. Decreased tissue perfusion, including cardiac, due to high ultrafiltration volumes (UFVs) is considered to be one of the drivers of cardiac dysfunction. While central venous oxygen saturation (ScvO2) is frequently used as an indicator of cardiac output in non-uremic populations, the relationship of ScvO2 and UFV in HD patients remains unclear. Our aim was to determine how intradialytic ScvO2 changes associate with UFV.
Methods:
We conducted a 6-month retrospective cohort study in maintenance HD patients with central venous catheters as vascular access. Intradialytic ScvO2 was measured with the Critline monitor. We computed treatment-level slopes of intradialytic ScvO2 over time (ScvO2 trend) and applied linear mixed effects models to assess the association between patient-level ScvO2 trends and UFV corrected for body weight (cUFV).
Results:
We studied 6042 dialysis sessions in 232 patients. In about 62.4% of treatments, ScvO2 decreased. We observed in nearly 80% of patients an inverse relationship between cUFV and ScvO2 trend, indicating that higher cUFV is associated with steeper decline in ScvO2 during dialysis.
Conclusions:
In most patients, higher cUFV volumes are associated with steeper intradialytic ScvO2 drops. We hypothesize that in a majority of patients the intradialytic cardiac function is fluid dependent, so that in the face of high ultrafiltration rates or volume, cardiac pre-load and consequently cardiac output decreases. Direct measurements of cardiac hemodynamics are warranted to further test this hypothesis.
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