Cerebral blood flow regulation in end-stage kidney disease

Justin D. Sprick, Joe R. Nocera, Ihab Hajjar, W. Charles O'Neill, James Bailey, Jeanie Park

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or "stunning." Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO2may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.

Original languageEnglish (US)
Pages (from-to)F782-F791
JournalAmerican Journal of Physiology - Renal Physiology
Issue number5
StatePublished - Nov 2020
Externally publishedYes


  • Brain blood flow
  • Cerebral autoregulation
  • Cerebrovascular reactivity
  • Chronic kidney disease
  • End-stage renal disease

ASJC Scopus subject areas

  • Physiology
  • Urology


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