Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients

Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO.sub.2) of hemodialysis (HD) patients is limited. We aimed to ide...

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Published in:	PloS one Vol. 15; no. 8; p. e0236720
Main Authors:	Ookawara, Susumu, Ito, Kiyonori, Sasabuchi, Yusuke, Hayasaka, Hideyuki, Kofuji, Masaya, Uchida, Takayuki, Horigome, Keita, Imai, Sojiro, Akikawa, Toshiko, Wada, Noriko, Kiryu, Satoshi, Imada, Satoru, Shindo, Mitsutoshi, Miyazawa, Haruhisa, Hirai, Keiji, Onishi, Yasushi, Shimoyama, Hirofumi, Watanabe, Akihisa, Tabei, Kaoru, Morishita, Yoshiyuki, Golebiewska, Justyna
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 10-08-2020 Public Library of Science (PLoS)
Subjects:	Albumin Anemia Biology and Life Sciences Blood pressure Care and treatment Cerebrum Coefficients Cognitive ability Diabetes Diabetes mellitus Generalized linear models Hemodialysis Hemodialysis patients Hemoglobin Hemoglobins Hospitals Infrared spectra Infrared spectroscopy Integrative medicine Internal medicine Kidney diseases Kidneys Linearity Management Medicine Medicine and Health Sciences Methods Mortality Near infrared radiation Near infrared spectroscopy Nephrology Oxygen Oxygen content Oxygenation Patients pH effects Physical Sciences Physiologic monitoring Physiological aspects Regression analysis Research and Analysis Methods Saturation Sensors Serum albumin Spectrum analysis Spline functions Statistical models Studies Values Japan
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Summary:	Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO.sub.2) of hemodialysis (HD) patients is limited. We aimed to identify these associations to consider a target Hb level for renal anemia management. This study included 375 HD patients. Cerebral rSO.sub.2 before HD was monitored using the INVOS 5100c oxygen saturation monitor. Multivariable linear regression analysis showed that cerebral rSO.sub.2 was independently associated with natural logarithm (Ln)-HD duration (standardized coefficient: -0.36), mean blood pressure (standardized coefficient: 0.13), pH (standardized coefficient: -0.10), serum albumin (standardized coefficient: 0.14), presence of diabetes mellitus (standardized coefficient: -0.20), and Hb level (standardized coefficient: 0.29). Furthermore, a generalized linear model with restricted cubic spline function was used to investigate the non-linear association between cerebral rSO.sub.2 and Hb levels. In the multivariable analysis for the adjustment with Ln-HD duration, mean blood pressure, pH, serum albumin, and presence of diabetes mellitus, a linear relationship was demonstrated between the two variables (p for linearity = 0.79). Hb levels revealed the positive and significant association with cerebral rSO.sub.2 in this study. Moreover, the relationship between cerebral rSO.sub.2 and Hb level was proven to be linear. Therefore, the target Hb level in renal anemia management would be considered to be the upper limits for the appropriate management of renal anemia by previous guidelines and position statement from the viewpoint of maintaining cerebral oxygenation in HD patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: Hakuyukai Medical Corporation provided support in the form of salaries for authors KH, TA, S. Imada, HS, and AW. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0236720