Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan.
Sci Rep. 2023 Feb 13;13(1):2576. doi: 10.1038/s41598-023-29879-0.
In hemodialysis (HD) patients with arteriovenous fistula (AVF), changes in systemic or peripheral tissue circulation occur non-physiologically via the presence of AVF; however, associations between blood flow and tissue oxygenation in the brain and access hand are uncertain. In this study, 85 HD patients with AVF were included and evaluated for changes in flow volume (FV) and regional oxygen saturation (rSO) in the brain and hands with AVF before and after percutaneous transluminal angioplasty (PTA). Furthermore, we evaluated the factors that determine access hand rSO without stenosis after PTA. Brachial arterial FV increased after PTA (p < 0.001), and carotid FV decreased (p = 0.008). Access hand rSO significantly decreased after PTA (p < 0.001), but cerebral rSO did not significantly change (p = 0.317). In multivariable linear regression analysis of factors associated with access hand rSO, serum creatinine (standardized coefficient: 0.296) and hemoglobin (standardized coefficient: 0.249) were extracted as independent factors for access hand rSO. In conclusion, a decrease in access hand oxygenation and maintenance of cerebral oxygenation were observed throughout PTA. To maintain access hand oxygenation, it is important to adequately manage Hb level and maintain muscle mass, in addition to having an AVF with appropriate blood flow.
在动静脉瘘(AVF)的血液透析(HD)患者中,通过 AVF 会发生非生理性的全身或外周组织循环变化;然而,大脑和瘘侧手部的血流量和组织氧合之间的关联尚不确定。在这项研究中,纳入了 85 例接受经皮腔内血管成形术(PTA)的 AVF 血液透析患者,并评估了 AVF 前后大脑和手部血流量(FV)和局部氧饱和度(rSO)的变化。此外,我们还评估了 PTA 后无狭窄的瘘侧手部 rSO 的决定因素。PTA 后肱动脉 FV 增加(p<0.001),颈动脉 FV 减少(p=0.008)。PTA 后瘘侧手部 rSO 显著降低(p<0.001),但大脑 rSO 无显著变化(p=0.317)。在 PTA 后与瘘侧手部 rSO 相关的多变量线性回归分析中,血清肌酐(标准化系数:0.296)和血红蛋白(标准化系数:0.249)被提取为瘘侧手部 rSO 的独立因素。总之,在整个 PTA 过程中观察到瘘侧手部氧合降低和大脑氧合维持。为了维持瘘侧手部的氧合,除了要有适当血流的动静脉瘘外,重要的是要充分管理血红蛋白水平和保持肌肉质量。