Increased Cerebral Blood Flow in Anemic Patients on Long-Term Hemodialytic Treatment

Abstract

CBF was measured in 15 patients on chronic hemodialytic treatment. CBF was measured with xenon-133 inhalation using single photon emission tomography. In addition, computerized tomography (CT) and a neurological examination were done prior to hemodialysis. Mean CBF was 66.2 ± 17.3 (SD) ml 100 g⁻¹ min⁻¹, which was significantly higher ( t-test, p < 0.05) than for an age-matched control group (54.7 ± 10.2 ml 100 g⁻¹ min⁻¹). However, the hematocrit for the patients was considerably lower, 0.30 ± 0.07, as compared to 0.43 ± 0.03 in the controls. A significant negative correlation was observed between CBF and the hematocrit ( y = –1.79x + 120.7, r = −0.71, p < 0.01). Calculating CBF from this equation in the dialyzed patients using a hematocrit of 0.43 yielded a mean CBF value of 43.7 ml 100 g⁻¹ min⁻¹, i.e., 20% below the expected. Two patients showed a focal CBF decrease. CT showed central or cortical atrophy in five patients, and two had small hypodense lesions. The neurological examination revealed slight to moderate dementia in seven cases. Although mean CBF was found to be increased by 21% as compared to the control group, an even higher CBF level would have been expected to outweigh the decreased oxygen carrying capacity of the blood. The findings suggest a lowered metabolic demand of the brain tissue, probably due to subtle brain damage.