Cerebral perfusion during intermittent hemodialysis in patients with acute kidney injury and advanced liver cirrhosis

Background: Cerebral blood flow (CBF) decreases during intermittent hemodialysis (HD) in patients with acute kidney injury (AKI). Since cerebral hemodynamics may be impaired in liver cirrhosis (LC), this condition could aggravate cerebral hypoperfusion during HD in patients with AKI. We examined CBF during the first HD session in patients admitted for AKI, with or without LC. Methods: CBF was examined by measuring middle cerebral artery mean flow velocity (MCAmfv) with transcranial Doppler at baseline and at the end of the first 4-hour HD session in 11 patients with both AKI and LC (median age 69 years, range 40-87, 7 men). Eleven patients with AKI without LC (median age 77 years, range 69-92, 6 men) served as controls. Results: Median net ultrafiltration volume at the end of the HD session was slightly, albeit not significantly, smaller in the patients with LC than in those without (-0.25 kg [range 0.00 to -1.50] vs. -1.00 kg [range 0.00 to -2.00], p = 0.18). At end of HD session, median MCAmfv had decreased by -5.5 cm/s (range -41.3 to 9.9) in the patients with LC, and by -4.5 cm/s (range -11.0 to -2.5) in those without LC (p = 0.79). At end of HD session, the mean MCAmfv of the 2 groups, adjusted for baseline MCAmfv and net ultrafiltration volume, was 25.7 and 21.1 cm/s in AKI patients with and without LC, respectively (difference between groups: 4.6 cm/sec; 95% confidence interval, -3.8 to + 13.0). Conclusion: In patients with AKI, concomitant LC does not confer greater vulnerability to cerebral hypoperfusion during intermittent HD.