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Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or \u201cstunning.\u201d Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO<jats:sub>2<\/jats:sub>may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.<\/jats:p>","DOI":"10.1152\/ajprenal.00438.2020","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T10:41:45Z","timestamp":1601289705000},"page":"F782-F791","source":"Crossref","is-referenced-by-count":48,"title":["Cerebral blood flow regulation in end-stage kidney disease"],"prefix":"10.1152","volume":"319","author":[{"given":"Justin D.","family":"Sprick","sequence":"first","affiliation":[{"name":"Division of Renal Medicine, Department of Medicine, Emory University Department of Medicine, Atlanta, Georgia"},{"name":"Department of Veterans Affairs Health Care System, Decatur, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe R.","family":"Nocera","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Health Care System, Decatur, Georgia"},{"name":"Center for Visual and Neurocognitive Rehabilitation, Department of Veterans Affairs Health Care System, Decatur, Georgia"},{"name":"Departments of Neurology and Rehabilitation Medicine, Emory University Department of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihab","family":"Hajjar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Emory University Department of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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