{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:22:07Z","timestamp":1755796927145,"version":"3.44.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"8","funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K24DK110427"],"award-info":[{"award-number":["K24DK110427"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL148182"],"award-info":[{"award-number":["R01HL148182"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Hemoglobin affinity for oxygen is modulated by ambient oxygen tension, acid\/base status, 2,3 diphosphoglycerate (2,3DPG) concentrations and other factors, facilitating tissue oxygenation under changing conditions. 2,3DPG is a key regulator of oxygen affinity within red blood cells and its levels are affected by blood phosphate. P50, the partial pressure of oxygen at which 50% of its hemoglobin binding sites are occupied, is a marker of oxygen delivery to tissues. We measured P50 during hemodialysis and explored its relationship with mineral metabolites and left ventricular strain as a marker of cardiac function.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Venous blood gas and other laboratory parameters were measured in 20 prevalent patients pre- and post-hemodialysis. To avoid arterio-venous mixing, we selected patients dialyzing through tunneled dialysis catheters. Associations of P50 with demographics, laboratory parameters and echocardiographic measurements were examined using linear regression models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>P50 levels decreased from 27.1\u00a0\u00b1\u00a00.9\u00a0mmHg to 26.2\u00a0\u00b1\u00a00.7\u00a0mmHg during hemodialysis (P\u00a0&amp;lt;\u00a0.001). Among 18 predictors evaluated, older age, and greater reductions in phosphate during hemodialysis were the strongest predictors of P50 changes in multivariate models. There was acute worsening in left ventricular global longitudinal strain (LVGLS) during hemodialysis (reduction of 1.4\u00a0\u00b1\u00a03.9%; P\u00a0=\u00a0.03). Greater reductions in P50 during hemodialysis and older age were significantly associated with greater reductions in LVGLS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Hemodialysis consistently reduces P50. The magnitude of P50 change was strongly associated with concurrent phosphate changes. P50 reductions correlated with acute lowering of LVGLS. These observations illuminate a potential cause of systemic tissue hypoxia and potential cardiac dysfunction during hemodialysis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfaf233","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T11:30:27Z","timestamp":1753183827000},"source":"Crossref","is-referenced-by-count":0,"title":["Effects of hemodialysis on hemoglobin oxygen affinity and cardiac function"],"prefix":"10.1093","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-0163","authenticated-orcid":false,"given":"Shilpa","family":"Sharma","sequence":"first","affiliation":[{"name":"David Geffen School of Medicine at UCLA, and VA Greater Los Angeles Healthcare System Division of Nephrology, Department of Medicine, , CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8854-2976","authenticated-orcid":false,"given":"Kim-Lien","family":"Nguyen","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA, and VA Greater Los Angeles Healthcare System Division of Cardiology, Department of Medicine,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isidro B","family":"Salusky","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA Department of Pediatrics, , Los Angeles, CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas","family":"Ganz","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA Department of Medicine,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim H","family":"Ix","sequence":"additional","affiliation":[{"name":"Division of Nephrology-Hypertension, University of California San Diego , , San Diego, CA , USA"},{"name":"and Veterans Affairs San Diego Healthcare System , , San Diego, CA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"2025081805010844600_bib1","doi-asserted-by":"publisher","first-page":"S112","DOI":"10.1053\/ajkd.1998.v32.pm9820470","article-title":"Clinical epidemiology of cardiovascular disease in chronic renal disease","volume":"32","author":"Foley","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"2025081805010844600_bib2","doi-asserted-by":"publisher","first-page":"98","DOI":"10.3945\/an.113.004655","article-title":"Phosphorus and the kidney: what is known and what is needed","volume":"5","author":"Nadkarni","year":"2014","journal-title":"Adv Nutr"},{"key":"2025081805010844600_bib3","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"2025081805010844600_bib4","doi-asserted-by":"publisher","first-page":"74","DOI":"10.2215\/CJN.02160214","article-title":"Reductions in red blood cell 2,3-diphosphoglycerate concentration during continuous renal replacment therapy","volume":"10","author":"Sharma","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025081805010844600_bib5","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1681\/ASN.2020050716","article-title":"Intracellular phosphate and ATP depletion measured by magnetic resonance spectroscopy in patients receiving maintenance hemodialysis","volume":"32","author":"Chazot","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"2025081805010844600_bib6","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1681\/ASN.2021111493","article-title":"Differences in phosphate and parathyroid hormone concentrations over the day among patients on hemodialysis","volume":"33","author":"Ginsberg","year":"2022","journal-title":"J Am Soc Nephrol"},{"key":"2025081805010844600_bib7","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.2215\/CJN.04470709","article-title":"Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025081805010844600_bib8","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1161\/CIRCIMAGING.109.862334","article-title":"Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring","volume":"2","author":"Stanton","year":"2009","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025081805010844600_bib9","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.jcmg.2007.12.007","article-title":"Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range","volume":"2","author":"Marwick","year":"2009","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025081805010844600_bib10","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1476-7120-7-8","article-title":"A new 2D-based method for myocardial velocity strain and strain rate quantification in a normal adult and paediatric population: assessment of reference values","volume":"7","author":"Bussadori","year":"2009","journal-title":"Cardiovasc Ultrasound"},{"key":"2025081805010844600_bib11","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.2215\/CJN.02680314","article-title":"Intradialytic hypotension and risk of cardiovascular disease","volume":"9","author":"Stefansson","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025081805010844600_bib12","first-page":"109","article-title":"Red cell function at extreme altitude on Mount Everest","volume":"56","author":"Winslow","year":"1984","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"2025081805010844600_bib13","doi-asserted-by":"publisher","first-page":"788","DOI":"10.3390\/jcm11030788","article-title":"Temporal Changes in the oxyhemoglobin dissociation curve of critically ill COVID-19 patients","volume":"11","author":"Ceruti","year":"2022","journal-title":"J Clin Med"},{"key":"2025081805010844600_bib14","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1085\/jgp.92.4.449","article-title":"Sodium-phosphate cotransport in human red blood cells. Kinetics and role in membrane metabolism","volume":"92","author":"Shoemaker","year":"1988","journal-title":"J Gen Physiol"},{"key":"2025081805010844600_bib15","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1097\/00000441-198803000-00004","article-title":"Reversible depression of myocardial performance in hypophosphatemia","volume":"295","author":"Davis","year":"1988","journal-title":"Am J Med Sci"},{"key":"2025081805010844600_bib16","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1111\/hdi.12971","article-title":"Predialysis serum phosphate and intradialytic hypotension","volume":"26","author":"Ravi","year":"2022","journal-title":"Hemodial Int"},{"key":"2025081805010844600_bib17","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.1016\/j.jacc.2010.06.044","article-title":"Longitudinal and circumferential strain rate, left ventricular remodeling, and prognosis after myocardial infarction","volume":"56","author":"Hung","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2025081805010844600_bib18","doi-asserted-by":"publisher","first-page":"2751","DOI":"10.1016\/j.jacc.2014.01.073","article-title":"Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review","volume":"63","author":"Thavendiranathan","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2025081805010844600_bib19","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1681\/ASN.2014020222","article-title":"Association of mortality risk with various definitions of intradialytic hypotension","volume":"26","author":"Flythe","year":"2015","journal-title":"J Am Soc Nephrol"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfaf233\/63862349\/sfaf233.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/18\/8\/sfaf233\/63862349\/sfaf233.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/18\/8\/sfaf233\/63862349\/sfaf233.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T09:01:17Z","timestamp":1755507677000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfaf233\/8215201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,28]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfaf233","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"type":"print","value":"2048-8505"},{"type":"electronic","value":"2048-8513"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,28]]},"article-number":"sfaf233"}}