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Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis

INTRODUCTION: The liver receives gut-derived endotoxin via the portal vein, clearing it before it enters systemic circulation. Hemodialysis negatively impacts the perfusion and function of multiple organs systems. Dialysate cooling reduces hemodialysis-induced circulatory stress and protects organs...

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Autores principales: Marants, Raanan, Qirjazi, Elena, Lai, Ka-Bik, Szeto, Cheuk-Chun, Li, Philip K.T., Li, Fiona, Lee, Ting-Yim, McIntyre, Christopher W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116762/
https://www.ncbi.nlm.nih.gov/pubmed/34013112
http://dx.doi.org/10.1016/j.ekir.2021.02.008
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author Marants, Raanan
Qirjazi, Elena
Lai, Ka-Bik
Szeto, Cheuk-Chun
Li, Philip K.T.
Li, Fiona
Lee, Ting-Yim
McIntyre, Christopher W.
author_facet Marants, Raanan
Qirjazi, Elena
Lai, Ka-Bik
Szeto, Cheuk-Chun
Li, Philip K.T.
Li, Fiona
Lee, Ting-Yim
McIntyre, Christopher W.
author_sort Marants, Raanan
collection PubMed
description INTRODUCTION: The liver receives gut-derived endotoxin via the portal vein, clearing it before it enters systemic circulation. Hemodialysis negatively impacts the perfusion and function of multiple organs systems. Dialysate cooling reduces hemodialysis-induced circulatory stress and protects organs from ischemic injury. This study examined how hemodialysis disrupts liver hemodynamics and function, its effect on endotoxemia, and the potential protective effect of dialysate cooling. METHODS: Fifteen patients were randomized to receive either standard (36.5°C dialysate temperature) or cooled (35.0°C) hemodialysis first in a two-visit crossover trial. We applied computed tomography (CT) liver perfusion imaging to patients before, 3 hours into and after each hemodialysis session. We measured hepatic perfusion and perfusion heterogeneity. Hepatic function was measured by indocyanine green (ICG) clearance. Endotoxin levels in blood throughout dialysis were also measured. RESULTS: During hemodialysis, overall liver perfusion did not significantly change, but portal vein perfusion trended towards increasing (P = 0.14) and perfusion heterogeneity significantly increased (P = 0.038). In addition, ICG clearance decreased significantly during hemodialysis (P = 0.016), and endotoxin levels trended towards increasing during hemodialysis (P = 0.15) and increased significantly after hemodialysis (P = 0.037). Applying dialysate cooling trended towards abrogating these changes but did not reach statistical significance compared to standard hemodialysis. CONCLUSION: Hemodialysis redistributes liver perfusion, attenuates hepatic function, and results in endotoxemia. Higher endotoxin levels in end-stage renal disease (ESRD) patients may result from the combination of decreased hepatic clearance function and increasing fraction of liver perfusion coming from toxin-laden portal vein during hemodialysis. The protective potential of dialysate cooling should be explored further in future research studies.
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spelling pubmed-81167622021-05-18 Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis Marants, Raanan Qirjazi, Elena Lai, Ka-Bik Szeto, Cheuk-Chun Li, Philip K.T. Li, Fiona Lee, Ting-Yim McIntyre, Christopher W. Kidney Int Rep Clinical Research INTRODUCTION: The liver receives gut-derived endotoxin via the portal vein, clearing it before it enters systemic circulation. Hemodialysis negatively impacts the perfusion and function of multiple organs systems. Dialysate cooling reduces hemodialysis-induced circulatory stress and protects organs from ischemic injury. This study examined how hemodialysis disrupts liver hemodynamics and function, its effect on endotoxemia, and the potential protective effect of dialysate cooling. METHODS: Fifteen patients were randomized to receive either standard (36.5°C dialysate temperature) or cooled (35.0°C) hemodialysis first in a two-visit crossover trial. We applied computed tomography (CT) liver perfusion imaging to patients before, 3 hours into and after each hemodialysis session. We measured hepatic perfusion and perfusion heterogeneity. Hepatic function was measured by indocyanine green (ICG) clearance. Endotoxin levels in blood throughout dialysis were also measured. RESULTS: During hemodialysis, overall liver perfusion did not significantly change, but portal vein perfusion trended towards increasing (P = 0.14) and perfusion heterogeneity significantly increased (P = 0.038). In addition, ICG clearance decreased significantly during hemodialysis (P = 0.016), and endotoxin levels trended towards increasing during hemodialysis (P = 0.15) and increased significantly after hemodialysis (P = 0.037). Applying dialysate cooling trended towards abrogating these changes but did not reach statistical significance compared to standard hemodialysis. CONCLUSION: Hemodialysis redistributes liver perfusion, attenuates hepatic function, and results in endotoxemia. Higher endotoxin levels in end-stage renal disease (ESRD) patients may result from the combination of decreased hepatic clearance function and increasing fraction of liver perfusion coming from toxin-laden portal vein during hemodialysis. The protective potential of dialysate cooling should be explored further in future research studies. Elsevier 2021-02-09 /pmc/articles/PMC8116762/ /pubmed/34013112 http://dx.doi.org/10.1016/j.ekir.2021.02.008 Text en © 2021 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Marants, Raanan
Qirjazi, Elena
Lai, Ka-Bik
Szeto, Cheuk-Chun
Li, Philip K.T.
Li, Fiona
Lee, Ting-Yim
McIntyre, Christopher W.
Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis
title Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis
title_full Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis
title_fullStr Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis
title_full_unstemmed Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis
title_short Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis
title_sort exploring the link between hepatic perfusion and endotoxemia in hemodialysis
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116762/
https://www.ncbi.nlm.nih.gov/pubmed/34013112
http://dx.doi.org/10.1016/j.ekir.2021.02.008
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