Cerebral and myocardial hypoperfusion occur during hemodialysis in adults. Pediatric patients receiving chronic hemodialysis have fewer cardiovascular risk factors, yet cardiovascular morbidity remains prominent.

We conducted a prospective observational study of pediatric patients receiving chronic hemodialysis to investigate whether intermittent hemodialysis is associated with adverse end organ effects in the heart or with cerebral oxygenation (regional tissue oxyhemoglobin saturation [rSO2]). We assessed intradialytic cardiovascular function and rSO2 using noninvasive echocardiography to determine myocardial strain and continuous noninvasive near-infrared spectroscopy for rSO2. We measured changes in blood volume and measured central venous oxygen saturation (mCVO2) pre-, mid-, and post-hemodialysis.

The study included 15 patients (median age, 12 years; median hemodialysis vintage, 13.2 [9–24] months). Patients were asymptomatic. The rSO2 did not change during hemodialysis, whereas mCVO2 decreased significantly, from 73% to 64.8%. Global longitudinal strain of the myocardium worsened significantly by mid-hemodialysis and persisted post-hemodialysis. The ejection fraction remained normal. Lower systolic BP and faster blood volume change were associated with worsening myocardial strain; only blood volume change was significant in multivariate analysis (β-coefficient, –0.3; 95% confidence interval [CI], –0.38 to –0.21; P<0.001). Blood volume change was also associated with a significant decrease in mCVO2 (β-coefficient, 0.42; 95% CI, 0.07 to 0.76; P=0.001). Access, age, hemodialysis vintage, and ultrafiltration volume were not associated with worsening strain.

Unchanged rSO2 suggested that cerebral oxygenation was maintained during hemodialysis. However, despite maintained ejection fraction, intradialytic myocardial strain worsened in pediatric hemodialysis and was associated with blood volume change. The effect of hemodialysis on individual organ perfusion in pediatric versus adult patients receiving hemodialysis might differ.

成人血液透析期间会发生大脑和心肌低灌注。接受慢性血液透析的儿科患者心血管危险因素较少，但心血管疾病发病率仍然突出。

我们对接受长期血液透析的儿科患者进行了一项前瞻性观察研究，以调查间歇性血液透析是否与心脏终末器官不良反应或脑氧合（局部组织氧合血红蛋白饱和度 [rSO2]）有关。我们使用无创超声心动图评估透析中的心血管功能和 rSO2 以确定心肌应变，并使用连续无创近红外光谱法评估 rSO2。我们测量了血容量的变化，并测量了血液透析前、中期和后的中心静脉血氧饱和度 (mCVO2)。

该研究包括 15 名患者（中位年龄，12 岁；中位血液透析时间，13.2 [9-24] 个月）。患者无症状。rSO2 在血液透析期间没有变化，而 mCVO2 显着下降，从 73% 下降到 64.8%。血液透析中期和血液透析后持续存在，心肌的整体纵向应变显着恶化。射血分数保持正常。较低的收缩压和较快的血容量变化与心肌应变恶化有关；在多变量分析中只有血容量变化显着（β系数，–0.3；95% 置信区间 [CI]，–0.38 至 –0.21；P <0.001）。血容量变化也与 mCVO2 显着降低相关（β系数，0.42；95% CI，0.07 至 0.76；P = 0.001）。通路、年龄、血液透析年份和超滤量与应变恶化无关。

不变的 rSO2 表明在血液透析期间维持脑氧合。然而，尽管射血分数保持不变，但透析期间心肌应变在儿科血液透析中恶化，并且与血容量变化有关。血液透析对接受血液透析的儿科患者和成人患者个体器官灌注的影响可能不同。