Cerebral blood flow regulation in end-stage kidney disease.

Cerebral blood flow regulation in end-stage kidney disease. Am J Physiol Renal Physiol. 2020 Sep 28;: Authors: Sprick JD, Nocera J, Hajjar I, O'Neill WC, Bailey JL, Park J Abstract Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD, and how the maintenance of cerebral oxygenation may be compromised during HD. ESKD patients exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or "stunning". Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remain relatively unexplored. In particular, cerebral autoregulation can oppose reduct...
Source: American Journal of Physiology. Renal Physiology - Category: Physiology Authors: Tags: Am J Physiol Renal Physiol Source Type: research

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