The effect of circulatory dysfunction upon the liver in haemodialysis patients

Grant, Claire (2019) The effect of circulatory dysfunction upon the liver in haemodialysis patients. PhD thesis, University of Nottingham.

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Abstract

Intermittent haemodialysis (HD) leads to recurrent circulatory stress which causes subclinical ischaemic injury and cumulative dysfunction in a variety of vulnerable organs. The effects of HD upon the liver have never been explored in detail. However, the liver is a haemodynamically active organ and plays a key role in the chronic inflammatory response modulation, as well as host defence against infection.

This project was designed to study the effects of both volume overload and circulatory stress, both characteristic of HD, upon liver haemodynamics in HD patients using serial imaging. The aims of the project were to evaluate the hepatic haemodynamic response to dialysis and explore the hepatic consequences of HD-induced circulatory stress. Three studies were conducted. The first examining the effect of dialysis upon liver stiffness, the second examining hepatic water content before and after dialysis, in comparison to overall fluid status and peripheral fluid shifts, and the third examining hepatic perfusion serially during dialysis.

Hepatic congestion does not appear to be prevalent in HD patients even in the presence of significant fluid overload. However, HD acutely affects hepatic perfusion and appears to lead to a degree of functional compromise. Perturbation of regional haemodynamics is associated with intra-dialytic haemodynamic stability and uraemic toxin clearance. There was considerable heterogeneity in the observed effects of dialysis, which appeared to relate to vulnerability to systemic circulatory stress.

The liver is affected by the circulatory stress of dialysis. Physiological mechanisms to preserve central circulating volume appear intact in HD patients. However, microcirculatory dysfunction and temporary functional compromise within the liver may impact upon the evolution of cardiac injury and toxin exposure in HD patients. Further work is needed to assess the full impact of hepatic disturbance in HD patients and its overall clinical significance.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Taal, Maarten
Keywords: Haemodialysis, Liver, Circulation
Subjects: W Medicine and related subjects (NLM Classification) > WI Digestive system
W Medicine and related subjects (NLM Classification) > WJ Urogenital system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 56854
Depositing User: Grant, Claire
Date Deposited: 30 Aug 2019 13:42
Last Modified: 07 May 2020 10:01
URI: http://eprints.nottingham.ac.uk/id/eprint/56854

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