Difference in Cerebral and Hepatic Oxygenation in Response to Ultrafiltration in a Hemodialysis Patient With Congestive Heart Failure

Near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO(2)), and intradialytic tissue rSO(2) measurements have been playing an important role in evaluating changes in tissue oxygenation in various clinical settings of hemodialysis (HD) therapy.However, few reports have described changes in hepatic oxygenation associated with body fluid management in overhydrated HD patients. We herein report an HD patient with congestive heart failure (CHF) that had improved systemic and tissue oxygenation, including in the brain and liver, during HD with ultrafiltration. A 73-year-old man undergoing HD was admitted to our hospital with CHF. After admission, HD with ultrafiltration was performed to adequately manage his body fluid excess. Because of deterioration of systemic oxygenation on admission, we monitored his percutaneous arterial oxygen saturation (SpO(2)) using a pulse oximeter and regional oxygen saturation (rSO(2)) in the brain and liver using an INVOS 5100c oxygen saturation monitor during HD. At HD initiation, his cerebral and hepatic rSO(2) levels were relatively low, at 43.2% and 34.1%, respectively, in addition to the SpO(2) of 88%. During HD with ultrafiltration, systemic oxygenation evaluated by SpO(2) and tissue oxygenation by cerebral and hepatic rSO(2) improved. Interestingly, the hepatic rSO(2) ratio, defined as the ratio of rSO(2) values at t (min) during HD and the initial rSO(2) value before HD, increased larger than the cerebral rSO(2) ratio during HD. After the adjustment of body fluid condition under the maintained SpO(2) values, we confirmed the hepatic and cerebral SO(2) ratio again during HD, and these two values changed nearly in the same manner. Throughout our experience, in this case, we confirmed a remarkable increase in hepatic rSO(2) ratio relative to cerebral rSO(2) ratio under a CHF status during HD, and these differences disappeared after the adjustment of the body fluid status.