Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension

Abstract Intradialytic hypotension (IDH) is a hemodynamic phenomenon recently associated with decreased blood oxygen saturation (SO2). The ratio between peripheral oxygen saturation (SpO2) and central venous SO2 (ScvO2) or Oxygen Extraction Ratio (OER), which represents a roughly estimate of the amo...

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Autores principales:	Silverio Rotondi, Lida Tartaglione, Natalia De Martini, Domenico Bagordo, Sara Caissutti, Marzia Pasquali, Maria Luisa Muci, Sandro Mazzaferro
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fb293d7f40284092ac7e2af6f5e4f7c7
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spelling	oai:doaj.org-article:fb293d7f40284092ac7e2af6f5e4f7c72021-12-02T11:37:18ZOxygen extraction ratio to identify patients at increased risk of intradialytic hypotension10.1038/s41598-021-84375-72045-2322https://doaj.org/article/fb293d7f40284092ac7e2af6f5e4f7c72021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-84375-7https://doaj.org/toc/2045-2322Abstract Intradialytic hypotension (IDH) is a hemodynamic phenomenon recently associated with decreased blood oxygen saturation (SO2). The ratio between peripheral oxygen saturation (SpO2) and central venous SO2 (ScvO2) or Oxygen Extraction Ratio (OER), which represents a roughly estimate of the amount of oxygen claimed by peripheral tissues, might be used to estimate haemodialysis (HD) related hypoxic stress. Aim of this pilot study was to evaluate the relationship between OER increments during dialysis sessions (ΔOER) and episodes of IDH. We enrolled chronic HD patients with permanent central venous catheter (CVC) and no fistula, in whom ScvO2 measurement is at hand. OER ([(SpO2 − ScvO2)/SpO2] × 100) was measured in three consecutive HD sessions (HD OER sessions) before HD, after 15′, 30′ and 60′ min and at the end of HD. Then, a one-year follow-up was planned to record the number of IDH episodes. In the 28 enrolled patients (age 74 ± 2.6 years), during 12 ± 1.2 months of follow up, incidence of IDH was 3.6%. We divided patients into two groups, above or below the median value of ΔOER at the end of HD, which was 36%. In these groups, the average incidence of IDH was 7% and 2% respectively (p < 0.01), while OER values before HD were not different. Notably, in the high ΔOER group the OER increment was evident since after 15′ and was significantly higher than in the low ∆OER group (∆OER-15′ = 19 ± 3.0% vs. 9.0 ± 3.0%; p < 0.05). By comparison, blood volume changes overlapped in the two groups (average change − 9 ± 0.8%). Values of ∆OER > 19% after only 15′ of HD treatment or > 36% at the end of the session characterize patients with higher rates of hypotension. Intradialytic ∆OER, a parameter of tissue hypoxic stress, identifies more fragile patients at greater risk of IDH.Silverio RotondiLida TartaglioneNatalia De MartiniDomenico BagordoSara CaissuttiMarzia PasqualiMaria Luisa MuciSandro MazzaferroNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Silverio Rotondi Lida Tartaglione Natalia De Martini Domenico Bagordo Sara Caissutti Marzia Pasquali Maria Luisa Muci Sandro Mazzaferro Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
description	Abstract Intradialytic hypotension (IDH) is a hemodynamic phenomenon recently associated with decreased blood oxygen saturation (SO2). The ratio between peripheral oxygen saturation (SpO2) and central venous SO2 (ScvO2) or Oxygen Extraction Ratio (OER), which represents a roughly estimate of the amount of oxygen claimed by peripheral tissues, might be used to estimate haemodialysis (HD) related hypoxic stress. Aim of this pilot study was to evaluate the relationship between OER increments during dialysis sessions (ΔOER) and episodes of IDH. We enrolled chronic HD patients with permanent central venous catheter (CVC) and no fistula, in whom ScvO2 measurement is at hand. OER ([(SpO2 − ScvO2)/SpO2] × 100) was measured in three consecutive HD sessions (HD OER sessions) before HD, after 15′, 30′ and 60′ min and at the end of HD. Then, a one-year follow-up was planned to record the number of IDH episodes. In the 28 enrolled patients (age 74 ± 2.6 years), during 12 ± 1.2 months of follow up, incidence of IDH was 3.6%. We divided patients into two groups, above or below the median value of ΔOER at the end of HD, which was 36%. In these groups, the average incidence of IDH was 7% and 2% respectively (p < 0.01), while OER values before HD were not different. Notably, in the high ΔOER group the OER increment was evident since after 15′ and was significantly higher than in the low ∆OER group (∆OER-15′ = 19 ± 3.0% vs. 9.0 ± 3.0%; p < 0.05). By comparison, blood volume changes overlapped in the two groups (average change − 9 ± 0.8%). Values of ∆OER > 19% after only 15′ of HD treatment or > 36% at the end of the session characterize patients with higher rates of hypotension. Intradialytic ∆OER, a parameter of tissue hypoxic stress, identifies more fragile patients at greater risk of IDH.
format	article
author	Silverio Rotondi Lida Tartaglione Natalia De Martini Domenico Bagordo Sara Caissutti Marzia Pasquali Maria Luisa Muci Sandro Mazzaferro
author_facet	Silverio Rotondi Lida Tartaglione Natalia De Martini Domenico Bagordo Sara Caissutti Marzia Pasquali Maria Luisa Muci Sandro Mazzaferro
author_sort	Silverio Rotondi
title	Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
title_short	Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
title_full	Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
title_fullStr	Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
title_full_unstemmed	Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
title_sort	oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/fb293d7f40284092ac7e2af6f5e4f7c7
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Oxygen extraction ratio to identify patients at increased risk of intradialytic hypotension

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