Central Venous Oxygen Saturation: A Potential New Marker for Circulatory Stress in Haemodialysis Patients?

Harrison, L.; Selby, Nicholas M.; McIntyre, Christopher W.

doi:10.1159/000362557

Cited by 27 publications

(40 citation statements)

References 17 publications

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“…In a variety of clinical situations ScvO 2 parallels SmvO 2 and is thus regarded as an indirect indicator of CO [19]. Given this physiological significance, ScvO 2 has been proposed as a marker of intradialytic hemodynamic stress in HD patients [20,23]. ScvO 2 has been shown to be lower in patients prone to IDH [16].…”

Section: Discussionmentioning

confidence: 99%

“…It is conceivable that rapid excursions of UBBF pose challenges to the CBF autoregulation. While a continuous measurement of upper body oxygen consumption during dialysis is elusive, the continuous measurement of SaO 2 is well established in clinical routine and could provide valuable additional information in future studies [16,18,19,23,[26][27][28][39][40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

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Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

et al. 2018

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Background: Central venous oxygen saturation (ScvO₂) is correlated with cardiac output. In most patients, ScvO₂ declines during hemodialysis (HD) due to factors such as reduced preload, myocardial stunning, and intermittent arrhythmias. Previous research has shown that low ScvO₂ is associated with higher mortality in chronic HD patients. In this research, we tested the hypothesis that ScvO₂ variability is associated with all-cause mortality. Methods: We conducted a retrospective study in 232 chronic HD patients with central venous catheter as vascular access. ScvO₂ was recorded 1× per minute during dialysis using the Crit-Line monitor. A 6-month baseline comprising at least 10 dialysis treatments with ScvO₂ recordings preceded a follow-up period of up to 3 years. The coefficient of variation (CV) of ScvO₂ (100 times the ratio of the standard deviation and mean of ScvO₂) served as a measure of ScvO₂ stability during baseline. Patients were stratified by median population CV of ScvO₂ during baseline, and survival during follow-up was compared between the 2 groups by Kaplan Meier and multivariate Cox analysis. The association between CV of ScvO₂ and all-cause mortality during follow-up was further assessed by Cox analysis with a spline term for CV of ScvO₂. Results: The mean CV ± standard deviation of ScvO₂ in our population was 6.1 ± 2.7% and the median was 5.3%. Univariate Kaplan-Meier analysis (p = 0.043) and multivariate Cox analysis (hazard ratio [HR] 1.16; p = 0.0005) indicated that a CV of ScvO₂ > 5.3% was significantly associated with increased mortality. In Cox analysis with spline term, a CV of ScvO₂ > 11% was associated with a significantly increased HR for all-cause mortality. Conclusion: High ScvO₂ variability during dialysis is associated with increased all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

et al. 2018

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“…For this purpose, changes in central venous oxygen saturation (ScvO 2 ), which can be assessed in patients treated with a central venous catheter, is an integrated parameter influenced by cardiac output, tissue oxygen delivery and oxygen extraction, predominantly of the upper body [35]. While ScvO 2 above 70% is considered optimal, most HD patients already start the dialysis treatment with substantially lower values [35, 36]. ScvO 2 is influenced by ultrafiltration rate [36], whereas the change may be different in patients prone to IDH.…”

Section: Changes In Perfusion Are Important But How Can They Be Measmentioning

confidence: 99%

“…While ScvO 2 above 70% is considered optimal, most HD patients already start the dialysis treatment with substantially lower values [35, 36]. ScvO 2 is influenced by ultrafiltration rate [36], whereas the change may be different in patients prone to IDH. In a study in 11 hypotension-prone and 9 stable HD patients, ScvO 2 dropped by 7.7% ± 1.7 in hypotension prone patients, in contrast to a rise of 1.0 ± 1.3% in the stable group.…”

Section: Changes In Perfusion Are Important But How Can They Be Measmentioning

confidence: 99%

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

et al. 2018

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Background: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. Summary: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia. Recent studies have stressed the relevance of changes in tissue perfusion during HD, which may translate in long-term organ damage. Monitoring changes in tissue perfusion, for which emerging evidence becomes available, appears to have great promise in the fine-tuning of the dialysis procedure. Key Messages: While it is unlikely that IDH can be completely prevented, reduction in inter-dialytic weight gain, prevention of an increase in core temperature by adjusting the dialysate temperature and more frequent or prolonged dialysis treatment remain cornerstones in providing a more comfortable and safe treatment.

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“…More than 20 years ago, it has been demonstrated that SaO 2 decreases during extracorporeal renal replacement therapy [2], and recently, a comparable obser- vation has been made for ScvO 2 [3]. The purpose of this review is to provide an overview about intradialytic SaO 2 and ScvO 2 during HD and its clinical correlates.…”

Section: Introductionmentioning

confidence: 99%

Intradialytic Hypoxemia in Chronic Hemodialysis Patients

Campos

Chan²,

Zhang³

et al. 2016

Blood Purif

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When kidney failure occurs, patients are at risk for fluid overload states, which can cause pulmonary edema, pleural effusions, and upper airway obstruction. Kidney disease is also associated with impaired respiratory function, as in central sleep apnea or chronic obstructive pulmonary disease. Hence, respiratory and renal diseases are frequently coexisting. Hypoxemia is the terminal pathway of a multitude of respiratory pathologies. The measurement of oxygen saturation (SO₂) is a basic and commonly used tool in clinical practice. Both arterial oxygen saturation (SaO₂) and central venous oxygen saturation (ScvO₂) can be easily obtained in hemodialysis (HD) patients, SaO₂ from an arteriovenous access and ScvO₂ from a central catheter. Here, we give a brief overview of the anatomy and physiology of the respiratory system, and the different technologies that are currently available to measure oxygen status in dialysis patients. We then focus on literature regarding intradialytic SaO₂ and ScvO₂. Lastly, we present clinical vignettes of intradialytic drops in SaO₂ and ScvO₂ in association with different symptoms and clinical scenarios with an emphasis on the pathophysiology of these cases. Given the fact that in the general population hypoxemia is associated with adverse outcomes, including increased mortality, cardiac arrhythmias and cardiovascular events, we posit that intradialytic SO₂ may serve as a potential marker to identify HD patients at increased risk for morbidity and mortality.

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Central Venous Oxygen Saturation: A Potential New Marker for Circulatory Stress in Haemodialysis Patients?

Cited by 27 publications

References 17 publications

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

Intradialytic Hypoxemia in Chronic Hemodialysis Patients

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