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Hypoxia during maintenance hemodialysis : the critical role of pH
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McGuire, Scott, Krishnan, Nithya, Malik, Abdul R., Waddell, Alex, Russell, Sophie L., Denton, Francesca, Ennis, Stuart, Horton, Elizabeth, Jakovljevic, Djordje and McGregor, Gordon (2023) Hypoxia during maintenance hemodialysis : the critical role of pH. Clinical Kidney Journal, 16 (2). pp. 262-271. doi:10.1093/ckj/sfac191 ISSN 2048-8505.
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WRAP-Hypoxia-during-maintenance-hemodialysis-the-critical-role-of-pH-McGregor-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (639Kb) | Preview |
Official URL: http://dx.doi.org/10.1093/ckj/sfac191
Abstract
Background
The impact and management of subclinical hypoxia during hemodialysis is a significant medical challenge. As key determinants of O2 availability and delivery, proposed mechanisms contributing to hypoxia include ischemia, alkalemia and pulmonary leukocyte sequestration. However, no study has comprehensively investigated and compared these interrelated mechanisms throughout a typical hemodialysis treatment week. This study aimed to comprehensively assess the physiological mechanisms that contribute to hypoxia during hemodialysis.
Methods
In 76 patients, we measured arterial blood gases and pH at four time-points during hemodialysis (start, 15 min, 60 min, end) over the course of a standard treatment week. For the mid-week hemodialysis session, we additionally measured central hemodynamics (non-invasive cardiac output monitoring) and white blood cell count.
Results
Linear regression modelling identified changes in pH, but not central hemodynamics or white blood cell count, to be predictive of changes in PaO2 throughout hemodialysis (e.g. at 60 min, β standardized coefficient pH = 0.45, model R2 = 0.25, P < .001). Alkalemia, hypokalemia, decreased calcium and increased hemoglobin–O2 affinity (leftward shift in the oxyhemoglobin dissociation curve) were evident at the end of hemodialysis. pH and hemoglobin–O2 affinity at the start of hemodialysis increased incrementally over the course of a standard treatment week.
Conclusion
These data highlight the important role of pH in regulating O2 availability and delivery during hemodialysis. Findings support routine pH monitoring and personalized dialysate bicarbonate prescription to mitigate the significant risk of alkalemia and subclinical hypoxia.
Item Type: | Journal Article | ||||||
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Subjects: | Q Science > QP Physiology R Medicine > RB Pathology R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Hemodialysis, Hydrogen-ion concentration, Anoxemia, Leucocytes | ||||||
Journal or Publication Title: | Clinical Kidney Journal | ||||||
Publisher: | Oxford University Press | ||||||
ISSN: | 2048-8505 | ||||||
Official Date: | February 2023 | ||||||
Dates: |
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Volume: | 16 | ||||||
Number: | 2 | ||||||
Page Range: | pp. 262-271 | ||||||
DOI: | 10.1093/ckj/sfac191 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 17 October 2022 | ||||||
Date of first compliant Open Access: | 18 October 2022 | ||||||
RIOXX Funder/Project Grant: |
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