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BJA Advance Access published online on November 5, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei016
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted September 21, 2004

Clinical Investigation

Cerebral haemodynamics in patients with chronic renal failure: effects of haemodialysis{dagger}

H. Skinner 1*, C. Mackaness 2, N. Bedforth 1, and R. Mahajan 1

1 Department of Anaesthesia, Nottingham City Hospital and Queen's Medical Centre, Nottingham, UK
2 Department of Anaesthesia, Derby Royal Infirmary, London Road, Derby, UK

* To whom correspondence should be addressed.
H. Skinner, E-mail: hskinne1{at}ncht.trent.nhs.uk


  Abstract

Background. We measured middle cerebral artery (MCA) flow velocity (FV), dynamic pressure autoregulation, and carbon dioxide reactivity (CRCO2) in patients with chronic renal failure before and after haemodialysis using transcranial Doppler ultrasonography.

Methods. Twelve patients on long-term haemodialysis were recruited. MCA FV was measured continuously. The transient hyperaemic response test was used to assess cerebral autoregulation, and per cent change in FV per kPa change in end-tidal carbon dioxide was calculated to assess CRCO2. All measurements were recorded before and after haemodialysis.

Results. MCA FV (mean [SD]) decreased from 57 (10) cm s-1 before to 46 (13) cm s-1 after haemodialysis (P<0.01). The transient hyperaemic response ratio (THRR) was (mean [SD]) 1.29 (0.13) before haemodialysis and did not change significantly following haemodialysis (1.36 [0.10]). CRCO2 was 21.7 (8.3)% kPa-1 before haemodialysis and remained unchanged afterwards (20.9 [3.8]% kPa-1). Values in normal subjects for MCA FV, THRR and CRCO2 are 56 (12) cm s-1, 1.26 (0.13) and 22 (6)% kPa-1, respectively.

Conclusions. MCA FV decreases significantly after haemodialysis. Dynamic pressure autoregulation and CRCO2 remain normal in patients with chronic renal failure, and are not altered significantly by haemodialysis.

Keywords: brain, cerebral autoregulation; blood, cerebral blood flow; blood, haemodialysis; complications, chronic renal failure; carbon dioxide, reactivity; monitoring, transient hyperaemic response.

{dagger} Presented at the European Society of Anaesthesiologists Annual Congress Amsterdam, May 1999.


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