Study On Cerebrovascular Reactivity And Neurovascular Coupling Function In Patients With End-stage Renal Disease Before And After Renal Transplantation

Objective:1.To explore the correlation between cerebrovascular reactivity and neurovascular coupling function in patients with end-stage renal disease.2.To investigate the effects of renal transplantation on cerebrovascular reactivity and neurovascular coupling function.Method:this study included a total of 145 hospitalized patients in the Renal Transplantation Department of the Second Affiliated Hospital of Hainan Medical College from February 2021 to February 2023,all of whom completed exercise test(ET)under functional Transcranial Doppler(TCD)cerebral blood flow monitoring.On the basis of completing the functional TCD test mentioned above,the subjects lay flat for another 10 minutes and underwent breath holding training to complete the breath holding test.Systolic velocity(Vs),Diastolic velocity(Vd)and Mean velocity(Vm)were recorded respectively to calculate the related parameters of middle cerebral artery baseline blood flow velocity,exercise induced blood flow velocity,gain,time to peak(TTP),area under curve(AUC),breath holding index(BHI),etc.,and collect relevant clinical data.Renal transplant patients were re evaluated for functional TCD and completed breath holding tests within 2 weeks after surgery.Analyze the characteristics of cerebrovascular reactivity and neurovascular coupling function before and after kidney transplantation through statistical analysis.Result:1.A total of 103 subjects were included in this study,including 52 cases(51%)in the CVR reduction group;There were 51 cases(49%)in the normal CVR group.Compared with the CVR normal group,the CVR normal group had a higher glomerular filtration rate,and the difference was statistically significant(P<0.01).Compared with the CVR normal group,the CVR normal group had lower red blood cell count,and the difference was statistically significant(P<0.01).2.Systolic velocity of time to peak(TTP-Vs)for cerebral hemodynamic parameters reflecting neurovascular coupling function: the normal CVR group was significantly higher than the CVR reduced group,and the difference was statistically significant(P<0.01);Mean velocity of time to peak(TTP-Vm): the normal CVR group was significantly higher than the reduced CVR group,with a statistically significant difference(P<0.05).3.A total of 55 patients were included in the kidney transplant group,including42 males(76%)and 13 females.Compared with the preoperative group,the postoperative group had lower hemoglobin,higher white blood cell count,creatinine indicating significant improvement in renal function,significantly increased glomerular filtration rate,and decreased postoperative systolic blood pressure,all of which were statistically significant(P<0.01).4.Comparison of baseline Vs of breath-holding test in patients before kidney transplantation: the cerebral blood flow in the group after kidney transplantation was greater than that in the group before kidney transplantation,and the cerebral blood flow velocity increased after kidney transplantation,with a statistically significant difference(P<0.05).Comparison of BHI(Vs)of patients before and after kidney transplantation: BHI in the group after kidney transplantation was greater than that in the group before kidney transplantation,and the systolic breath-holding index improved after kidney transplantation,the difference was statistically significant(P<0.01).Comparison of BHI(Vm)of patients before and after kidney transplantation: the average cerebral blood flow breath holding index after kidney transplantation increased significantly to the normal value,and the difference was statistically significant(P<0.01).5.Compared with the post kidney transplant group,the baseline Vm and Vs were lower in the pre kidney transplant group and higher in the post kidney transplant group,with statistically significant differences(P<0.01).Compared with the post kidney transplant group,the pre kidney transplant group showed a decrease in Vs and Vm induced by exercise,while the post kidney transplant group showed an increase,with a statistically significant difference(P<0.05).At the same time,the time of TTP-Vs,TTP-Vm,and TTP-Vd in the group after kidney transplantation was significantly reduced compared to the group before kidney transplantation,and there was a statistically significant difference(P<0.01).Conclusion:1.The neurovascular coupling function of patients with end-stage renal disease with impaired cerebrovascular reactivity decreased.2.The cerebrovascular reactivity and neurovascular coupling function of renal transplant patients improved after transplantation.3.TTP-Vs,TTP-Vm,and TTP-Vd can reflect potential markers of NVC function before and after kidney transplantation.