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Cerebral hypoxia in chronic kidney disease and its relation to cognitive decline
Kalendová, Lucie ; Malík, Jan (advisor) ; Bednářová, Vladimíra (referee) ; Janečková, Jana (referee)
Cerebral hypoxia in chronic kidney disease and its relation to cognitive decline Dissertation abstract - MUDr. Lucie Kalendová Introduction: Patients with chronic kidney disease in need of regular hemodialysis treatment have high rates of cognitive impairment. In its multifactorial etiology, vascular changes, cerebral ischemia and hypoxia play a major role. In our work we first studied the association between low cerebral oxygenation and cognitive impairment in this population. Subsequently, we focused on one of the possible etiological factors in this association - the presence of a vascular shunt for hemodialysis. Methods: Chronic hemodialysis patients without overt cognitive impairment participated in the studies. We used a near-infrared spectroscopy (NIRS) device named INVOS for monitoring cerebral oxygenation (rSO2). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA). To assess the effect of vascular shunt, we performed an interventional study based on short-term ultrasound-confirmed manual compression with continuous monitoring of rSO2. Results: In 39 patients (49 % women, age 64 ± 14 years) we observed a significantly lower rSO2 in the subgroup presenting cognitive decline than in patients without this diagnosis (48 ± 9 vs. 57 ± 10; p = 0.01). The association remained...
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Pharmacological possibilities for amending renal dysfunction in experimental model of heart failure
Krátký, Vojtěch ; Charvátová, Zuzana (advisor) ; Bednářová, Vladimíra (referee) ; Melenovský, Vojtěch (referee)
Mechanisms underlying the development of renal dysfunction and pharmacological possibilities for its amending in patients with chronic heart failure are still incompletely understood. The aim of the study was thus to compare the effect of treatment with an ACE inhibitor (ACEi), AT1 receptor blocker (ARB) or combined angiotensin receptor-neprilysin inhibitor (ARNi) on renal hemodynamic and excretory functions in experimental models of heart failure induced by placing an aorto-caval fistula (ACF) in combination with hypertension or preexisting renal disease. In normotensive and especially in hypertensive rats with high- output heart failure 20 weeks after ACF placement, ARB administration, dissimilarly to an ACEi treatment, was shown to prevent renal hypoperfusion and hypoxia. In addition, heart failure rats treated with ARB exhibited lower ROS generation, improved renal NO bioavailability, and normal renal SNS activity. The failure of ACEi to ameliorate renal hypoperfusion in rats with heart failure may be a consequence of insufficiently suppressed intrarenal RAS along with enhanced renal SNS activity in the face of depleted compensatory mechanisms, namely NO. Combined ARNi treatment in rats with induced heart failure superimposed on progressive renal dysfunction significantly improved survival...
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