| Theme |
Disorder of central nerve system in dialysis patients |
| Title |
Cerebral blood flow abnormalities in dialysis patients |
| Author |
Kiichiro Fujisaki |
Emergency and Critical Care Center, Kyushu University Hospital |
| Author |
Hideki Hirakata |
Fukuoka Red Cross Hospital |
| [ Summary ] |
Cerebral blood flow and cerebral oxygen metabolic rates are low in chronic maintenance hemodialysis (HD) patients. In other words, there is a failure in compensatory reactions related to cerebral blood flow and anemia. Cerebral oxygen metabolism rates are extremely low for these patients. They are not helped by administration of erythropoietin for anemia. Cerebral blood flow decreases with prolonged dialysis. There is a notable impact on the white matter and the frontal lobe.
The reasons for these abnormalities are factors such as metabolic disorders of the neuronal cells in the brain due to chronic uremic conditions, reduced blood flow, due to arteriosclerosis and abnormalities in circulation control mechanisms due to disturbances in the autonomic nervous system. Hemoconcentration and decreases in circulating blood volume due to water removal during normal dialysis contribute to cerebral blood flow reduction. In addition, cerebral blood flow reduction during HD and in patients with orthostatic hypotension after HD causes impairment of consciousness. From the viewpoint of protecting the brain, it is important that doctors establish dry-weights properly to stabilize blood pressure and they consider the use of vasopressors to preserve cerebral blood flow. |