The oxygen cascade in hemodialysis patients and native high altitude dwellers- Lessons from extreme physiology to benefit patients with end-stage renal disease.

The oxygen cascade in hemodialysis patients and native high altitude dwellers- Lessons from extreme physiology to benefit patients with end-stage renal disease. Am J Physiol Renal Physiol. 2020 Dec 28;: Authors: Kooman JP, Stenvinkel P, Shiels PG, Feelisch M, Canaud B, Kotanko P Abstract Hemodialysis patients repeatedly undergo intradialytic low arterial oxygen saturation, as well as low central venous oxygen saturation, reflecting an imbalance between upper body systemic oxygen supply and demand, which are associated with increased mortality. Abnormalities along the entire oxygen cascade, with impaired diffusive and convective oxygen transport, contribute to the reduced tissue oxygen supply. Dialysis treatment impairs pulmonary gas exchange and reduces ventilatory drive, whereas ultrafiltration can reduce tissue perfusion due to a decline in cardiac output. In addition to these factors, capillary rarefaction and reduced mitochondrial efficacy can further affect the balance between cellular oxygen supply and demand. Whereas it has been convincingly demonstrated that a reduced perfusion of heart and brain during dialysis contributes to organ damage, the significance of systemic hypoxia remains uncertain, although it may contribute to oxidative stress, systemic inflammation and accelerated senescence. These abnormalities along the oxygen cascade of dialysis patients appear to be diametrically opposite to the situation in Tibetan highla...
Source: Am J Physiol Renal P... - Category: Urology & Nephrology Authors: Tags: Am J Physiol Renal Physiol Source Type: research