Preserved cerebral oxygenation with worsening global myocardial strain during pediatric chronic hemodialysis

Background Cerebral and myocardial hypoperfusion occur during hemodialysis in adults. Pediatric patients receiving chronic hemodialysis have fewer cardiovascular risk factors, yet cardiovascular morbidity remains prominent. Methods We conducted a prospective observational study of pediatric patients receiving chronic hemodialysis to investigate whether intermittent hemodialysis is associated with adverse end organ effects in the heart or with cerebral oxygenation (regional O2 saturation [rSO2]). We assessed intradialytic cardiovascular function and rSO2, using noninvasive echocardiography to determine myocardial strain and continuous noninvasive near-infrared spectroscopy for rSO2. We measured changes in blood volume and central venous oxygen saturation (mCVO2) were pre-, mid-, and post-hemodialysis. Results The study included 15 patients (median age, 12 years; median hemodialysis vintage 13.2 [9, 24] months were included. Patients were asymptomatic. The rSO2 did not change during hemodialysis, whereas mCVO2 decreased significantly, from 73% to 64.8 %. Global longitudinal strain of the myocardium worsened significantly by mid-hemodialysis and persisted post-hemodialysis. The ejection fraction remained normal. Lower systolic blood pressure and faster blood volume change were associated with worsening myocardial strain; only blood volume change was significant in multivariate analysis (β coefficient, -0.3; 95% confidence interval [95% CI], ~0.38 to ~0.21; P=0.0001). Blood volume change was also associated with a significant decrease in mCVO2 (β coefficient 0.42; 95% CI, 0.07 to 0.76; P=0.001). Access, age, hemodialysis vintage, and ultrafiltration volume were not associated with worsening strain. Conclusions Unchanged rSO2 suggested that cerebral oxygenation was maintained during hemodialysis. However, despite maintained ejection fraction, intradialytic myocardial strain worsened in pediatric hemodialysis and was associated with blood volume change. The effect of hemodialysis on individual organ perfusion in pediatric versus adult patients receiving hemodialysis might differ.