Vanderlinden Jessica Anne, Holden Rachel Mary, Scott Stephen Harold, Boyd John Gordon
Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada.
Can J Kidney Health Dis. 2021 May 6;8:20543581211010654. doi: 10.1177/20543581211010654. eCollection 2021.
Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown.
To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters.
Prospective observational study.
Single-center tertiary academic teaching hospital in Ontario, Canada.
Six patients initiating HD were enrolled in the study.
Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm.
Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis.
This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters.
Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated.
Due to the feasibility nature of this study, no trial registration was performed.
已知接受血液透析（HD）的患者局部脑氧合（rSO2）值较低且认知功能受损。两者的病因目前尚不清楚。
确定对开始进行HD的患者连续监测rSO2的可行性。此外，我们试图研究rSO2与血流动力学和透析参数之间的关系。
前瞻性观察性研究。
加拿大安大略省的单中心三级学术教学医院。
6名开始进行HD的患者纳入本研究。
可行性定义为成功纳入研究（>1例患者/月）、成功同意率（>70%）、高数据捕获率（>90%）和评估耐受性。在透析的第一年，每周进行1次局部脑氧合监测。在研究期间进行3次神经心理学测试：透析开始前、透析开始后3个月和1年。神经心理学测试包括一种传统筛查工具：可重复神经心理状态评估量表，以及一种基于机器人的评估：Kinarm。
我们的总体同意率为33%，纳入率为0.4例患者/月。总共记录了243次rSO2监测，6名患者的数据捕获率为91.4%（222/243）。在整个研究过程中，未报告不良相互作用。rSO2与血流动力学和透析参数之间的相关性显示出个体患者的差异。然而，在个体水平上，所有患者的平均动脉压与rSO2之间均呈正相关。超滤量超过3升的患者与rSO2呈显著负相关。透析开始后检测到的认知障碍较少。
这个小队列限制了关于rSO2与血流动力学和透析参数之间关系的结论。
由于同意率和纳入率较低，在单个透析单元对患者进行前瞻性rSO2监测是不可行的。然而，rSO2监测可能为HD对脑氧合的影响提供独特见解，应进一步研究。
由于本研究的可行性性质，未进行试验注册。
