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. 2022 Dec 24;12(1):138.
doi: 10.3390/jcm12010138.

Oxygen Extraction and Mortality in Patients Undergoing Chronic Haemodialysis Treatment: A Multicentre Study

Silverio Rotondi  1   2 , Lida Tartaglione  3 , Maria Luisa Muci  1 , Marzia Pasquali  3 , Nicola Panocchia  4 , Filippo Aucella  5 , Antonio Gesuete  5 , Teresa Papalia  6 , Luigi Solmi  6 , Alessio Farcomeni  7 , Sandro Mazzaferro  2
Affiliations

Oxygen Extraction and Mortality in Patients Undergoing Chronic Haemodialysis Treatment: A Multicentre Study

Silverio Rotondi et al. J Clin Med. .

Abstract

Patients on haemodialysis (HD) suffer a high mortality rate linked to developing subclinical hypoxic parenchymal stress during HD sessions. The oxygen extraction ratio (OER), an estimate of the oxygen claimed by peripheral tissues, might represent a new prognostic factor in HD patients. This study evaluated whether the intradialytic change in OER (ΔOER) identified patients with higher mortality risks. We enrolled chronic HD patients with permanent central venous catheters with available central venous oxygen saturation (ScvO2) measurements; the arterial oxygen saturation was measured with peripheral oximeters (SpO2). We measured OER before and after HD at enrolment; deaths were recorded during two-years of follow-up. In 101 patients (age: 72.9 ± 13.6 years, HD vintage: 9.6 ± 16.6 years), 44 deaths were recorded during 11.6 ± 7.5 months of follow-up. Patients were divided into two groups according to a 40% ΔOER threshold (ΔOER < 40%, n = 56; ΔOER ≥ 40%, n = 45). The ΔOER ≥ 40% group showed a higher incidence of death (60% vs. 30%; p = 0.005). The survival curve (log-rank-test: p = 0.0001) and multivariate analysis (p = 0.0002) confirmed a ΔOER ≥ 40% as a mortality risk factor. This study showed the intradialytic ΔOER ≥ 40% was a mortality risk factor able to highlight critical hypoxic damage. Using a ΔOER ≥ 40% could be clinically applicable to characterise the most fragile patients.

Keywords: central venous catheter; central venous oxygen saturation; end-stage renal disease; haemodialysis; mortality; oxygen extraction; subclinical parenchymal hypoxia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
OER pre-HD and ΔOER during the follow-up. OER, oxygen extraction ratio; ∆OER, variation in OER.
Figure 2
Figure 2
Oxygen parameter in the two groups ΔOER ≥ 40% and ΔOER < 40%. ScvO2, central venous SO2; SaO2, arterial SO2; OER, oxygen extraction ratio; ∆OER, variation in OER.
Figure 3
Figure 3
Overall survival, ΔOER ≥ 40% vs. ΔOER < 40%. Time 0 was the date of the first haemodialysis session after enrolment. Kaplan–Meier log rank test, p = 0.001. OER, oxygen extraction ratio; ∆OER, variation in OER.
Figure 4
Figure 4
Incidence of causes of death in the entire population and in the ΔOER ≥ 40% and ΔOER < 40% groups. OER, oxygen extraction ratio; ∆OER, variation in OER.
See this image and copyright information in PMC

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