Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients

I. Ishida, H. Hirakata, H. Sugimori, T. Omae, E. Hirakata, S. Ibayashi, Michiaki Kubo, M. Fujishima

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60°head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 ± 3 years [mean ± SEM]; HD duration, 47 ± 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 ± 3 years; HD duration, 82 ± 23 months). Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 ± 6 versus 103 ± 4 mm H g; Hct, 26% ± 1% versus 28% ± 1%; fibrinogen, 355 ± 37 versus 357 ± 27 mg/dL; fluid, 2.5 ± 0.2 versus 2.3 ± 0.2 L). Percentage of change in VMCA (%VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 ± 5 mm Hg during tilt only in patients with DM. The degree of MBP reduction was -13 ± 2 mm Hg in DM and -2 ± 2 mm Hg in non-DM patients (P < 0.01). %VMCA equally decreased during tilt; DM, -12% ± 3%, and non-DM, -12% ± 2%. After HD; MBP decreased by 36 ± 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased in both groups after HD, and %VMCA in DM (-32% ± 5%) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13% ± 2%; P < 0.01). %VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0.87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM.

Original languageEnglish
Pages (from-to)1096-1104
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume34
Issue number6
DOIs
Publication statusPublished - 01-01-1999
Externally publishedYes

Fingerprint

Cerebrovascular Circulation
Blood Flow Velocity
Renal Dialysis
Diabetes Mellitus
Middle Cerebral Artery
Blood Pressure
Dizziness
Hematocrit
Fibrinogen
Doppler Transcranial Ultrasonography

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Ishida, I., Hirakata, H., Sugimori, H., Omae, T., Hirakata, E., Ibayashi, S., ... Fujishima, M. (1999). Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients. American Journal of Kidney Diseases, 34(6), 1096-1104. https://doi.org/10.1016/S0272-6386(99)70016-8
Ishida, I. ; Hirakata, H. ; Sugimori, H. ; Omae, T. ; Hirakata, E. ; Ibayashi, S. ; Kubo, Michiaki ; Fujishima, M. / Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients. In: American Journal of Kidney Diseases. 1999 ; Vol. 34, No. 6. pp. 1096-1104.
@article{d1d738dc29744ef8974583f668b594c5,
title = "Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients",
abstract = "Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60°head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 ± 3 years [mean ± SEM]; HD duration, 47 ± 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 ± 3 years; HD duration, 82 ± 23 months). Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 ± 6 versus 103 ± 4 mm H g; Hct, 26{\%} ± 1{\%} versus 28{\%} ± 1{\%}; fibrinogen, 355 ± 37 versus 357 ± 27 mg/dL; fluid, 2.5 ± 0.2 versus 2.3 ± 0.2 L). Percentage of change in VMCA ({\%}VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 ± 5 mm Hg during tilt only in patients with DM. The degree of MBP reduction was -13 ± 2 mm Hg in DM and -2 ± 2 mm Hg in non-DM patients (P < 0.01). {\%}VMCA equally decreased during tilt; DM, -12{\%} ± 3{\%}, and non-DM, -12{\%} ± 2{\%}. After HD; MBP decreased by 36 ± 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased in both groups after HD, and {\%}VMCA in DM (-32{\%} ± 5{\%}) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13{\%} ± 2{\%}; P < 0.01). {\%}VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0.87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM.",
author = "I. Ishida and H. Hirakata and H. Sugimori and T. Omae and E. Hirakata and S. Ibayashi and Michiaki Kubo and M. Fujishima",
year = "1999",
month = "1",
day = "1",
doi = "10.1016/S0272-6386(99)70016-8",
language = "English",
volume = "34",
pages = "1096--1104",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "6",

}

Ishida, I, Hirakata, H, Sugimori, H, Omae, T, Hirakata, E, Ibayashi, S, Kubo, M & Fujishima, M 1999, 'Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients', American Journal of Kidney Diseases, vol. 34, no. 6, pp. 1096-1104. https://doi.org/10.1016/S0272-6386(99)70016-8

Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients. / Ishida, I.; Hirakata, H.; Sugimori, H.; Omae, T.; Hirakata, E.; Ibayashi, S.; Kubo, Michiaki; Fujishima, M.

In: American Journal of Kidney Diseases, Vol. 34, No. 6, 01.01.1999, p. 1096-1104.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients

AU - Ishida, I.

AU - Hirakata, H.

AU - Sugimori, H.

AU - Omae, T.

AU - Hirakata, E.

AU - Ibayashi, S.

AU - Kubo, Michiaki

AU - Fujishima, M.

PY - 1999/1/1

Y1 - 1999/1/1

N2 - Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60°head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 ± 3 years [mean ± SEM]; HD duration, 47 ± 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 ± 3 years; HD duration, 82 ± 23 months). Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 ± 6 versus 103 ± 4 mm H g; Hct, 26% ± 1% versus 28% ± 1%; fibrinogen, 355 ± 37 versus 357 ± 27 mg/dL; fluid, 2.5 ± 0.2 versus 2.3 ± 0.2 L). Percentage of change in VMCA (%VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 ± 5 mm Hg during tilt only in patients with DM. The degree of MBP reduction was -13 ± 2 mm Hg in DM and -2 ± 2 mm Hg in non-DM patients (P < 0.01). %VMCA equally decreased during tilt; DM, -12% ± 3%, and non-DM, -12% ± 2%. After HD; MBP decreased by 36 ± 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased in both groups after HD, and %VMCA in DM (-32% ± 5%) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13% ± 2%; P < 0.01). %VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0.87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM.

AB - Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60°head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 ± 3 years [mean ± SEM]; HD duration, 47 ± 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 ± 3 years; HD duration, 82 ± 23 months). Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 ± 6 versus 103 ± 4 mm H g; Hct, 26% ± 1% versus 28% ± 1%; fibrinogen, 355 ± 37 versus 357 ± 27 mg/dL; fluid, 2.5 ± 0.2 versus 2.3 ± 0.2 L). Percentage of change in VMCA (%VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 ± 5 mm Hg during tilt only in patients with DM. The degree of MBP reduction was -13 ± 2 mm Hg in DM and -2 ± 2 mm Hg in non-DM patients (P < 0.01). %VMCA equally decreased during tilt; DM, -12% ± 3%, and non-DM, -12% ± 2%. After HD; MBP decreased by 36 ± 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased in both groups after HD, and %VMCA in DM (-32% ± 5%) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13% ± 2%; P < 0.01). %VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0.87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM.

UR - http://www.scopus.com/inward/record.url?scp=0032745246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032745246&partnerID=8YFLogxK

U2 - 10.1016/S0272-6386(99)70016-8

DO - 10.1016/S0272-6386(99)70016-8

M3 - Article

C2 - 10585320

AN - SCOPUS:0032745246

VL - 34

SP - 1096

EP - 1104

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 6

ER -