The gastro-intestinal tract is being increasingly recognized as the site of key pathophysiological processes in the hemodialysis patient. Intestinal dysbiosis, increased intraluminal toxin production, and increased intestinal permeability are commonly observed processes which contribute to the pathogenesis of cardiovascular disease and thus elevated mortality. The acute circulatory effects of dialysis itself may contribute significantly to the development of gastrointestinal dysfunction as a result of both local and distant effects. Additionally, the liver, a relatively unknown entity in this process, has a substantial role as a functional barrier between the portal and systemic circulation and in the metabolism of pathogenic gut-derived uremic toxins. Here we summarize the evidence for acute gastro-intestinal and hepatic effects of hemodialysis and identify gaps in knowledge to date which require further study.
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Hepato-splanchnic fluxes during exercise in patients with cirrhosis-a pilot study.
Physiol Rep
September 2024
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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- Cirrhotic patients experience compromised liver function, which can lead to fatigue during exercise due to altered metabolic processes and blood flow in the liver.
- In an experiment with eight cirrhotic patients performing incremental cycling trials, significant changes were observed in heart rate, hepatic blood flow, glucose output, and levels of lactate and ammonia during exercise.
- The findings suggest that while these patients maintain blood sugar levels during low-intensity workouts, the buildup of lactate and ammonia could hinder their overall ability to tolerate physical activity.
Hepatic Oxygenation Changes and Symptomatic Intradialytic Hypotension.
Kidney Blood Press Res
June 2024
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Introduction: Clinical studies on differences among changes in cerebral and hepatic oxygenation during hemodialysis (HD) in patients with and without intradialytic hypotension (IDH) are limited. We investigated changes in intradialytic cerebral and hepatic oxygenation before systolic blood pressure (SBP) reached the nadir during HD and compared these differences between patients with and without symptomatic IDH.
Methods: We analyzed data from 109 patients with (n = 23) and without (n = 86) symptomatic IDH who were treated with HD.
Factors affecting intradialytic hepatic oxygenation: Associations between ultrafiltration rate and changes in systemic blood pressure.
Int J Artif Organs
May 2023
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Article Synopsis
- Hepato-splanchnic circulation plays a crucial role in oxygenating abdominal organs and maintaining blood volume during hemodialysis (HD), but its relationship with clinical factors is not fully understood.
- A study with 91 HD patients measured hepatic oxygen saturation and found that those with intradialytic hypotension (IDH) experienced significantly greater decreases in liver oxygen levels compared to those without IDH.
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Association between hepatic oxygenation on near-infrared spectroscopy and clinical factors in patients undergoing hemodialysis.
PLoS One
November 2021
Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Article Synopsis
- The hepato-splanchnic circulation is crucial for oxygenating abdominal organs and compensating for blood volume loss during hemodialysis (HD), but assessing it clinically is challenging.
- A study involving 185 HD patients and 15 healthy controls found that hepatic regional oxygen saturation (rSO2) was significantly lower in HD patients compared to controls (56.4% vs. 76.2%).
- Factors such as body mass index (BMI), hemoglobin levels, cardiovascular disease history, mean blood pressure, and serum albumin concentration were linked to hepatic rSO2, indicating the need for further research on these parameters' impact during HD.
Defense mechanisms to increasing back pressure for hepatic oxygen transport and venous return in porcine fecal peritonitis.
Am J Physiol Gastrointest Liver Physiol
September 2020
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
High central venous pressure (CVP) acutely decreases venous return. How this affects hepatic oxygen transport in sepsis remains unclear. The aim of this study was to evaluate the effects of repeated increases in CVP via standard nursing procedures (NPs) on hepato-splanchnic and renal oxygen transport in a prolonged porcine sepsis model.
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