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Original

Brain swelling during dialysis: A randomized trial comparing low-flux hemodialysis with pre-dilution hemodiafiltration 

Niels Johansen, Christian Kjaergaard, Michael Peters, Bente Pedersen, Jens Jespersen

Volume 87 (2017) p. 221 - 230

Abstract

Clinical Nephrology, Vol. 87 – No. 5/2017 (221-230)

Brain swelling during dialysis: A randomized trial comparing low-flux hemodialysis with pre-dilution hemodiafiltration 

Niels Johansen¹, Krista Dybtved Kjaergaard¹, Christian Daugaard Peters¹, Michael Pedersen², Bente Jespersen¹, and Jens Dam Jensen¹

¹Department of Renal Medicine, Aarhus University Hospital, and ²Comparative Medicine Lab, Institute of Clinical Medicine, Aarhus University, Denmark
Osmotic changes in plasma are assumed to cause cerebral swelling in hemodialysis patients. We investigated the acute effect of low-flux hemodialysis (HD) (removal of small molecules) and pre-dilution hemodiafiltration (pre-HDF) (additional removal of larger molecules) on cerebral compartment volumes using quantitative magnetic resonance imaging (MRI) in chronic uremic patients. Twelve patients underwent a session of HD and pre-HDF in a randomized crossover study with equal ultrafiltration. MRI was performed immediately before and after dialysis. A linear correlation was found between changes in gray matter and plasma osmolarity (HD: r² = 0.83; HDF: r² = 0.73) but not between changes in white matter volume and plasma osmolarity (HD: r² = 0.02; HDF: r² = 0.004). Total brain volume increased by 1.8 ± 1.7% (18.7 ± 17.4 mL) (mean ± SD) during HD and 2.0 ± 0.9% (22.3 ± 10.7 mL) during pre-HDF. Gray matter volume increased: HD 3.8% (from –3.6 to 9.7) and pre-HDF 4.2% (from –2.8 to 14.3). White matter volume did not change significantly. Reduction ratio of urea (molecular weight (MW) 0.06 kDa) (HD: 68%; pre-HDF: 69.7%) and β2-microglobulin (MW 11.7 kDa) (HD: –13.7%; pre-HDF: 67.2%) separated the treatments. This study showed that HD and pre-HDF caused equal acute cerebral swelling of the grey matter. This appeared to be driven by small solute change in plasma interacting linearly with gray matter volume regardless of additional removal of larger molecules or ultrafiltration. Correspondence to:
Jens Dam Jensen, MD, PhD
Department of Renal Medicine
Aarhus University Hospital
Palle Juul-Jensens Boulevard 99
 8200 Aarhus N, Denmark 
Email: [email protected]

Original

Does hydration status influence kidney volume in autosomal dominant polycystic kidney disease? 

Signe Vinsand Naver, Anja Møller Jensen, Martin Egfjord, Bjarne Ørskov, Maria Grostøl Ørnhøj Østergaard, Anne Dorte Blankholm, Eva Fallentin, Michael Pedersen, and Jens Dam Jensen

Volume 100 (2023) p. 195 - 201

Abstract

Clinical Nephrology, Vol. 100 – No. 5/2023 (195-201)

Does hydration status influence kidney volume in autosomal dominant polycystic kidney disease? 

Signe Vinsand Naver¹, Anja Møller Jensen², Martin Egfjord¹, Bjarne Ørskov², Maria Grostøl Ørnhøj Østergaard³, Anne Dorte Blankholm⁴, Eva Fallentin⁵, Michael Pedersen⁶, and Jens Dam Jensen³

¹Department of Nephrology, Rigshospitalet, Copenhagen, ²Department of Nephrology, Zealand University Hospital, Roskilde, ³Department of Renal Medicine, Aarhus University Hospital, ⁴Department of Radiology, Aarhus University Hospital, Aarhus, ⁵Department of Radiology, Rigshospitalet, Copenhgen, and ⁶Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
Autosomal dominant polycystic kidney disease (ADPKD) is a progressive kidney disease where the size of the kidneys is correlated to the stage of kidney failure. Total kidney volume (TKV) is used as a prognostic marker to determine disease stage, progression, and possible effect of treatment. It has been shown that water restriction is associated with reduced kidney volume in healthy subjects. The aim of this study was to evaluate the relationship between TKV and hydration status in ADPKD patients. 40 ADPKD patients with chronic kidney disease stage 1 – 3 were randomized to either 3 hours of water restriction (n = 21) or 1 hour of water loading (n = 19; intake: 20 mL/kg). The patients had a mean age of 38 years (19 – 73) and mean plasma creatinine level of 91 (54 – 178) µmol/L. Magnetic resonance imaging of the kidneys was performed before and after intervention, and TKV was measured using the ellipsoid formula. Water restriction resulted in an insignificant 0.67% increase in TKV (median: 1.48, interquartile range (IQR): 6.1, range: –1. – 4.5). Water loading resulted in an insignificant 2.67% increase in TKV (median: 3.18, IQR: 11.4, range: –3.6 – 7.8). Interestingly, a 7.09% increase in right-kidney volume was found after water loading (median: 5.58, IQR: 9.4 range: 1.9 – 11.3, p < 0.05), whereas the left-kidney volume showed an insignificant decrease of 0.18% after water loading (median: –1.65, IQR: 18.0, range: –12.5 – 5.5). We found in ADPKD patients that neither short-term water restriction nor acute water loading had significant effects, suggesting that the use of TKV for disease staging is independent of hydration level in these patients.Correspondence to:
Dr. Signe Vinsand Naver
Department of Nephrology
Rigshospitalet
University of Copenhagen, Denmark
Email: [email protected]

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