{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:10:35Z","timestamp":1791655835341,"version":"4.3.4"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2018,4]]},"abstract":"\n The initiation of hemodialysis is associated with an accelerated decline of cognitive function and an increased incidence of cerebrovascular accidents and white matter lesions. Investigators have hypothesized that the repetitive circulatory stress of hemodialysis induces ischemic cerebral injury, but the mechanism is unclear. We studied the acute effect of conventional hemodialysis on cerebral blood flow (CBF), measured by [\n 15<\/jats:sup>\n O]H\n 2<\/jats:sub>\n O positron emission tomography\u2013computed tomography (PET-CT). During a single hemodialysis session, three [\n 15<\/jats:sup>\n O]H\n 2<\/jats:sub>\n O PET-CT scans were performed: before, early after the start of, and at the end of hemodialysis. We used linear mixed models to study global and regional CBF change during hemodialysis. Twelve patients aged \u226565 years (five women, seven men), with a median dialysis vintage of 46 months, completed the study. Mean (\u00b1SD) arterial BP declined from 101\u00b111 mm Hg before hemodialysis to 93\u00b117 mm Hg at the end of hemodialysis. From before the start to the end of hemodialysis, global CBF declined significantly by 10%\u00b115%, from a mean of 34.5 to 30.5 ml\/100g per minute (difference, \u22124.1 ml\/100 g per minute; 95% confidence interval, \u22127.3 to \u22120.9 ml\/100 g per minute;\n P<\/jats:italic>\n =0.03). CBF decline (20%) was symptomatic in one patient. Regional CBF declined in all volumes of interest, including the frontal, parietal, temporal, and occipital lobes; cerebellum; and thalamus. Higher tympanic temperature, ultrafiltration volume, ultrafiltration rate, and pH significantly associated with lower CBF. Thus, conventional hemodialysis induces a significant reduction in global and regional CBF in elderly patients. Repetitive intradialytic decreases in CBF may be one mechanism by which hemodialysis induces cerebral ischemic injury.\n <\/jats:p>","DOI":"10.1681\/asn.2017101088","type":"journal-article","created":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T14:05:34Z","timestamp":1519913134000},"page":"1317-1325","source":"Crossref","is-referenced-by-count":194,"title":["Hemodialysis Induces an Acute Decline in Cerebral Blood Flow in Elderly Patients"],"prefix":"10.1681","volume":"29","clinical-trial-number":[{"clinical-trial-number":"nct02272985","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Harmke A.","family":"Polinder-Bos","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3308-3167","authenticated-orcid":false,"given":"David V\u00e1llez","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Kuipers","sequence":"additional","affiliation":[{"name":"Dialysis Center Groningen, Groningen, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Willem J.","family":"Elting","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel J.H.","family":"Aries","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim P.","family":"Krijnen","sequence":"additional","affiliation":[{"name":"Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands;"},{"name":"Johann Bernoulli Institute for Mathematics and Computer Science, University of Groningen, Groningen, The Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk","family":"Groen","sequence":"additional","affiliation":[{"name":"Epidemiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoon T.M.","family":"Willemsen","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"van Laar","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fijanne","family":"Strijkert","sequence":"additional","affiliation":[{"name":"Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Luurtsema","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riemer H.J.A.","family":"Slart","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Westerhuis","sequence":"additional","affiliation":[{"name":"Dialysis Center Groningen, Groningen, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron T.","family":"Gansevoort","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo A.J.M.","family":"Gaillard","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Dermatology, Department of Nephrology, University Medical Center Utrecht, University of Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper F.M.","family":"Franssen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"issue":"Suppl 1","key":"B1-20231016","doi-asserted-by":"crossref","first-page":"A7","DOI":"10.1053\/j.ajkd.2016.12.004","article-title":"US renal data system 2016 annual data report: Epidemiology of kidney disease in the united states.","volume":"69","author":"Saran","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"B2-20231016","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1038\/ki.2011.368","article-title":"The contribution of chronic kidney disease to the global burden of major noncommunicable diseases.","volume":"80","author":"Couser","year":"2011","journal-title":"Kidney Int"},{"key":"B3-20231016","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1212\/01.wnl.0000225182.15532.40","article-title":"Cognitive impairment in hemodialysis patients is common.","volume":"67","author":"Murray","year":"2006","journal-title":"Neurology"},{"key":"B4-20231016","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1212\/WNL.0b013e31827f0f7f","article-title":"Frequency of and risk factors for poor cognitive performance in hemodialysis patients.","volume":"80","author":"Sarnak","year":"2013","journal-title":"Neurology"},{"key":"B5-20231016","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/ki.2010.336","article-title":"Dementia and cognitive impairment in ESRD: Diagnostic and therapeutic strategies.","volume":"79","author":"Kurella Tamura","year":"2011","journal-title":"Kidney Int"},{"key":"B6-20231016","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1053\/j.ackd.2008.01.010","article-title":"Cognitive impairment in the aging dialysis and chronic kidney disease populations: An occult burden.","volume":"15","author":"Murray","year":"2008","journal-title":"Adv Chronic Kidney Dis"},{"key":"B7-20231016","first-page":"89","article-title":"Cognitive function and advanced kidney disease: Longitudinal trends and impact on decision-making.","volume":"10","author":"Iyasere","year":"2017","journal-title":"Clin Kidney J"},{"key":"B8-20231016","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1093\/ndt\/gfs470","article-title":"Decline in renal functioning is associated with longitudinal decline in global cognitive functioning, abstract reasoning and verbal memory.","volume":"28","author":"Davey","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"B9-20231016","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1053\/j.ajkd.2016.11.015","article-title":"Cognitive decline and its risk factors in prevalent hemodialysis patients.","volume":"69","author":"Drew","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"B10-20231016","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.kint.2016.11.015","article-title":"Loss of executive function after dialysis initiation in adults with chronic kidney disease.","volume":"91","author":"Kurella Tamura","year":"2017","journal-title":"Kidney Int"},{"key":"B11-20231016","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1681\/ASN.2012080841","article-title":"Incidence of stroke before and after dialysis initiation in older patients.","volume":"24","author":"Murray","year":"2013","journal-title":"J Am Soc Nephrol"},{"key":"B12-20231016","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00330-014-3466-5","article-title":"Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: A diffusion-tensor study.","volume":"25","author":"Zhang","year":"2015","journal-title":"Eur Radiol"},{"key":"B13-20231016","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1148\/radiol.2523080484","article-title":"End-stage renal disease: In vivo diffusion-tensor imaging of silent white matter damage.","volume":"252","author":"Hsieh","year":"2009","journal-title":"Radiology"},{"key":"B14-20231016","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.3174\/ajnr.A3511","article-title":"Widespread white matter alterations in patients with end-stage renal disease: A voxelwise diffusion tensor imaging study.","volume":"34","author":"Chou","year":"2013","journal-title":"AJNR Am J Neuroradiol"},{"key":"B15-20231016","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1681\/ASN.2013101086","article-title":"Randomized clinical trial of dialysate cooling and effects on brain white matter.","volume":"26","author":"Eldehni","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"B16-20231016","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/ndt\/gfn501","article-title":"Haemodialysis is associated with a pronounced fall in myocardial perfusion.","volume":"24","author":"Dasselaar","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"B17-20231016","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2215\/CJN.03170707","article-title":"Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow.","volume":"3","author":"McIntyre","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"B18-20231016","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1053\/j.ajkd.2006.01.012","article-title":"Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis.","volume":"47","author":"Selby","year":"2006","journal-title":"Am J Kidney Dis"},{"key":"B19-20231016","doi-asserted-by":"crossref","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":"B20-20231016","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1038\/jcbfm.2014.92","article-title":"Comparison of cerebral blood flow acquired by simultaneous [15O]water positron emission tomography and arterial spin labeling magnetic resonance imaging.","volume":"34","author":"Zhang","year":"2014","journal-title":"J Cereb Blood Flow Metab"},{"key":"B21-20231016","first-page":"782","article-title":"Brain blood flow measured with intravenous H2(15)O. I. Theory and error analysis.","volume":"24","author":"Herscovitch","year":"1983","journal-title":"J Nucl Med"},{"key":"B22-20231016","first-page":"790","article-title":"Brain blood flow measured with intravenous H2(15)O. II. Implementation and validation.","volume":"24","author":"Raichle","year":"1983","journal-title":"J Nucl Med"},{"key":"B23-20231016","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1161\/01.STR.25.2.408","article-title":"Effects of hemodialysis on cerebral circulation evaluated by transcranial Doppler ultrasonography.","volume":"25","author":"Hata","year":"1994","journal-title":"Stroke"},{"key":"B24-20231016","doi-asserted-by":"crossref","first-page":"129","DOI":"10.5414\/CNP64129","article-title":"Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery.","volume":"64","author":"Stefanidis","year":"2005","journal-title":"Clin Nephrol"},{"key":"B25-20231016","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1093\/bja\/aei016","article-title":"Cerebral haemodynamics in patients with chronic renal failure: Effects of haemodialysis.","volume":"94","author":"Skinner","year":"2005","journal-title":"Br J Anaesth"},{"key":"B26-20231016","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1053\/ajkd.2002.36333","article-title":"Online monitoring of cerebral hemodynamics during hemodialysis.","volume":"40","author":"Metry","year":"2002","journal-title":"Am J Kidney Dis"},{"key":"B27-20231016","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1093\/ndt\/gfs182","article-title":"Cerebral blood flow decreases during intermittent hemodialysis in patients with acute kidney injury, but not in patients with end-stage renal disease.","volume":"28","author":"Regolisti","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"B28-20231016","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1161\/01.STR.22.12.1508","article-title":"Changes in middle cerebral artery blood velocity in uremic patients after hemodialysis.","volume":"22","author":"Postiglione","year":"1991","journal-title":"Stroke"},{"key":"B29-20231016","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1681\/ASN.V104854","article-title":"Effect of normalization of hematocrit on brain circulation and metabolism in hemodialysis patients.","volume":"10","author":"Metry","year":"1999","journal-title":"J Am Soc Nephrol"},{"key":"B30-20231016","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000076854","article-title":"Nitric oxide synthetic capacity in relation to dialysate temperature.","volume":"22","author":"Beerenhout","year":"2004","journal-title":"Blood Purif"},{"key":"B31-20231016","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1542-4758.2009.00355.x","article-title":"Cool dialysate reduces asymptomatic intradialytic hypotension and increases baroreflex variability.","volume":"13","author":"Chesterton","year":"2009","journal-title":"Hemodial Int"},{"issue":"Suppl 1","key":"B32-20231016","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1159\/000049119","article-title":"Perfusion thresholds in human cerebral ischemia: Historical perspective and therapeutic implications.","volume":"11","author":"Baron","year":"2001","journal-title":"Cerebrovasc Dis"},{"key":"B33-20231016","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/0271678X15606723","article-title":"Cerebral small vessel disease: Capillary pathways to stroke and cognitive decline.","volume":"36","author":"\u00d8stergaard","year":"2016","journal-title":"J Cereb Blood Flow Metab"},{"key":"B34-20231016","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1681\/ASN.2016060704","article-title":"Relationship between hypotension and cerebral ischemia during hemodialysis.","volume":"28","author":"MacEwen","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B35-20231016","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1159\/000358432","article-title":"Evaluation of cerebral oxygenation in patients undergoing long-term hemodialysis.","volume":"126","author":"Hoshino","year":"2014","journal-title":"Nephron Clin Pract"},{"key":"B36-20231016","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1038\/sj.jcbfm.9600478","article-title":"Cerebrovascular effects of hemodialysis in chronic kidney disease.","volume":"27","author":"Prohovnik","year":"2007","journal-title":"J Cereb Blood Flow Metab"},{"key":"B37-20231016","doi-asserted-by":"crossref","first-page":"855","DOI":"10.3109\/0886022X.2013.794675","article-title":"Cerebral oximetry values in dialyzed surgical patients: A comparison between hemodialysis and peritoneal dialysis.","volume":"35","author":"Papadopoulos","year":"2013","journal-title":"Ren Fail"},{"issue":"Suppl 1","key":"B38-20231016","doi-asserted-by":"crossref","first-page":"S129","DOI":"10.1053\/ajkd.2001.27421","article-title":"Depressed cerebral oxygen metabolism in patients with chronic renal failure: A positron emission tomography study.","volume":"38","author":"Kanai","year":"2001","journal-title":"Am J Kidney Dis"},{"key":"B39-20231016","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/S0272-6386(03)00906-5","article-title":"Circulating endothelial cells as potential markers of the state of the endothelium in hemodialysis patients.","volume":"42","author":"Ko\u00e7","year":"2003","journal-title":"Am J Kidney Dis"},{"key":"B40-20231016","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1111\/j.1523-1755.2005.00173.x","article-title":"Circulating endothelial cells are associated with future vascular events in hemodialysis patients.","volume":"67","author":"Koc","year":"2005","journal-title":"Kidney Int"},{"key":"B41-20231016","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1093\/ndt\/16.10.1968","article-title":"Endothelial dysfunction and inflammation-is there a link?","volume":"16","author":"Stenvinkel","year":"2001","journal-title":"Nephrol Dial Transplant"},{"key":"B42-20231016","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1161\/01.CIR.0000140262.20831.8F","article-title":"Serum myeloperoxidase levels independently predict endothelial dysfunction in humans.","volume":"110","author":"Vita","year":"2004","journal-title":"Circulation"},{"key":"B43-20231016","doi-asserted-by":"crossref","first-page":"e63493","DOI":"10.1371\/journal.pone.0063493","article-title":"Elevated circulating levels and tissue expression of pentraxin 3 in uremia: A reflection of endothelial dysfunction.","volume":"8","author":"Witasp","year":"2013","journal-title":"PLoS One"},{"key":"B44-20231016","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2214\/ajr.149.2.351","article-title":"MR signal abnormalities at 1.5 T in Alzheimer\u2019s dementia and normal aging.","volume":"149","author":"Fazekas","year":"1987","journal-title":"AJR Am J Roentgenol"},{"key":"B45-20231016","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1159\/000117417","article-title":"Qualitative assessment of cerebral atrophy on MRI: Inter- and intra-observer reproducibility in dementia and normal aging.","volume":"37","author":"Scheltens","year":"1997","journal-title":"Eur Neurol"},{"key":"B46-20231016","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1038\/jcbfm.1992.105","article-title":"Increased cerebral blood flow in anemic patients on long-term hemodialytic treatment.","volume":"12","author":"Vorstrup","year":"1992","journal-title":"J Cereb Blood Flow Metab"},{"key":"B47-20231016","first-page":"110","article-title":"Brain hemodynamics in patients with end-stage renal disease between hemodialysis sessions.","volume":"6","author":"Farhoudi","year":"2012","journal-title":"Iran J Kidney Dis"},{"key":"B48-20231016","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/ki.1985.119","article-title":"Regional cerebral blood flow in dialysis encephalopathy and primary degenerative dementia.","volume":"28","author":"Mathew","year":"1985","journal-title":"Kidney Int"}],"container-title":["Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00001751-201804000-00027","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T19:31:14Z","timestamp":1786131074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00001751-201804000-00027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,1]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1681\/asn.2017101088","relation":{},"ISSN":["1046-6673","1533-3450"],"issn-type":[{"value":"1046-6673","type":"print"},{"value":"1533-3450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,1]]}}}