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Doppler examination of cerebral arteries in uremic children
J Kwieciñski1, K Pierzchała, M Szczepañska
1Department of Neurology, Silesian School of Medicine, Zabrze, Poland.
Insights
Hemodialysis (HD) significantly reduces cerebral blood flow velocities in children with kidney failure. Blood flow changes correlate with blood pressure, not hematocrit or urea levels, indicating complex intradialytic effects.
Area of Science:
- Nephrology
- Neurology
- Pediatrics
Background:
- Cerebral circulation is crucial in children with kidney disease.
- Maintenance hemodialysis (HD) and pre-renal replacement therapy (RRT) impact patient physiology.
- Transcranial Doppler ultrasonography (TCD) is a non-invasive tool for assessing cerebral blood flow.
Purpose of the Study:
- To evaluate the effects of kidney disease and HD treatment on cerebral blood flow velocities in children.
- To compare cerebral circulation in children undergoing maintenance HD versus those pre-RRT.
- To identify factors influencing intradialytic changes in cerebral blood flow.
Main Methods:
- Utilized Transcranial Doppler ultrasonography (TCD) to measure blood flow velocities.
- Assessed cerebral arteries including internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA).
- Monitored changes during and before hemodialysis sessions, correlating with hemodynamic and laboratory parameters.
Main Results:
- Uremic children showed significantly lower blood flow velocities in major cerebral arteries 120 and 240 minutes into HD compared to pre-HD values.
- Changes in MCA and ACA velocities during HD correlated significantly with mean arterial pressure fluctuations.
- No significant correlation was found between velocity changes and intradialytic hematocrit, ultrafiltration, hemoglobin, or blood urea nitrogen.
Conclusions:
- Hemodialysis significantly alters cerebral blood flow velocities in pediatric uremic patients.
- Mean arterial pressure is a key factor influencing intradialytic cerebral blood flow changes.
- Further research is needed to elucidate the precise mechanisms behind intradialytic velocity alterations in uremic children.
Abstract:
Transcranial Doppler ultrasonography is a useful method for the estimation and monitoring of cerebral circulation in dialyzed patients. The aim of this study was to evaluate the effect of disease and treatment on cerebral circulation in children on maintenance hemodialysis (HD) and children prior to renal replacement therapy. We demonstrated that in uremic children blood flow velocities of the internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) 120 min and 240 min from the beginning of an HD session were significantly lower than values immediately before HD. Changes in blood flow velocities of MCA and ACA during HD correlated significantly with changes in mean arterial pressure during HD. There was no correlation between changes in blood flow velocities and intradialytic changes in hematocrit values, ultrafiltration, hemoglobin concentration, and blood urea nitrogen values. Mean blood flow velocities of ICA, MCA, and PCA in euvolemic children on conservative treatment were significantly higher than after a HD session in children on maintenance HD. The factors responsible for intradialytic velocity changes of cerebral arteries in uremic children require further examination.