Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
October 2nd, 2020
We present a protocol to measure regional oxygen saturation (rSO2) in hemodialysis (HD) patients by using a near-infrared spectroscopy monitor. The rSO2 value is an index of tissue oxygenation. This noninvasive and real-time monitoring could be useful for confirming changes in organ oxygenation during HD.
Using this method, we can understand oxygen dynamics of organ during hemodialysis. Prior to the development of this protocol, we could not confirm changes in regional oxygen of each organ. This simple technique can evaluate regional oxygen saturation, non-invasive and in real-time.
In dialysis patients, such monitoring might detect intradyalitic hypertension or length ischemia dry during HD.This neuro system has been used in several areas. Cardiovascular and cerebrovascular surgery, neonatal, intensive care, and prehospital emergency. We hope this monitoring will be used in other areas in the future.
For example, diagnosis of cognitive impairment. Begin by preparing a near-infrared spectroscopy or NIRS device for measuring tissue oxygenation. This device has four channels and can perform measurement in up to four organs at the same time.
In addition, prepare measurement sensors for NIRS monitoring to evaluate regional oxygen saturation values in each organ, by a transmitting near-infrared light at two wavelengths of attachment. Allow the patient to rest in a supine position for at least five minutes before hemodialysis. Then attach measurement sensors to the forehead, the right hypochondrium and lower legs to evaluate regional oxygen saturation in the brain, liver, and lower leg muscles, respectively.
For cerebral regional oxygen saturation measurement, attach the sensors to the forehead of the dominant hemisphere. For hepatic measurements, measure the depth of the patient's liver from the body surface, and confirm that this measurement is within 20 to 30 millimeters. Next, attach the measurement sensors to the right hypochondrium.
To monitor muscle oxygenation, attach measurement sensors to the right or bilateral lower legs. Connect each sensor to the leads from the device. Then, turn on the device and start measuring oxygenation.
Puncture the patient's dialysis shunt to start hemodialysis therapy. Measure blood pressure using a digital blood pressure monitor equipped with the dialysis machine, and collect blood samples using syringes. After starting therapy, start monitoring the tissue oxygenation of the three organs.
In addition to the usual monitoring performed during hemodialysis, observe changes in regional oxygen saturation values of each organ and measure blood pressure regularly. Confirm the attachment area and connection between the sensors and leads. Cerebral oxygen saturation values of hemodialysis patients before hemodialysis were lower than those of healthy subjects.
The saturation values of hemodialysis patients with diabetes mellitus were lower than those in hemodialysis patients without diabetes. Although tissue oxygenation continues without a decrease of blood pressure during hemodialysis, changes in cerebral and hepatic regional oxygen saturation due to intradyalitic hypotension were observed. When attempting this protocol, it is important to compound the location measurement sensors and to apply the sensors'registry.
The new system itself is not a new technique. However, the application of this monitoring system to hemodialysis is another and it is very useful to evaluate changes in organ oxygenation during hemodialysis.
View the full transcript and gain access to thousands of scientific videos
Overview
This article presents a protocol for measuring regional oxygen saturation (rSO2) in hemodialysis patients using a near-infrared spectroscopy monitor. This noninvasive and real-time monitoring technique is valuable for assessing changes in organ oxygenation during hemodialysis.
Key Study Components
Area of Science
- Neuroscience
- Nephrology
- Monitoring Techniques
Background
- Understanding oxygen dynamics in organs during hemodialysis is crucial.
- Prior methods did not allow for confirmation of changes in regional oxygen levels.
- This technique is non-invasive and provides real-time data.
- Potential applications include monitoring during cardiovascular and cerebrovascular surgeries.
Purpose of Study
- To develop a protocol for evaluating regional oxygen saturation in hemodialysis patients.
- To enhance monitoring capabilities during hemodialysis.
- To explore the use of this monitoring in various medical fields.
Methods Used
- Near-infrared spectroscopy monitoring.
- Real-time assessment of regional oxygen saturation.
- Application in hemodialysis settings.
- Evaluation of intradialytic hypertension and ischemia.
Main Results
- Successful measurement of rSO2 in hemodialysis patients.
- Ability to detect changes in organ oxygenation.
- Potential for broader application in other medical areas.
- Contribution to understanding organ oxygen dynamics.
Conclusions
- The protocol offers a reliable method for monitoring oxygen saturation.
- It can help identify complications during hemodialysis.
- Future applications may extend to various medical fields.
Frequently Asked Questions
Executive Industry Relevance
Monitoring tissue oxygenation in hemodialysis patients addresses a critical gap in understanding organ-specific responses to extracorporeal therapy, enabling mechanistic de-risking of hemodynamic interventions. This noninvasive, real-time method supports target validation by linking physiological changes to clinical outcomes such as intradialytic hypotension, thereby improving predictive confidence in preclinical and early clinical models of kidney disease.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables interrogation of tissue-specific oxygen dynamics to validate hemodynamic targets in kidney disease models.
- Operational Value: Provides real-time, quantitative rSO2 readouts for functional validation of organ-level responses during therapy simulation.
Screening & Assay Development
- Scientific Value: Generates standardized, reproducible oxygenation metrics across brain, liver, and muscle tissues for assay normalization.
- Operational Value: Facilitates multiplexed organ monitoring using a four-channel NIRS device, increasing throughput in preclinical screening workflows.
Translational & Preclinical Research
- Scientific Value: Supports disease-relevant system modeling by capturing organ-specific oxygenation changes during simulated hemodialysis conditions.
- Operational Value: Enables longitudinal tracking of rSO2 to assess therapeutic impact on tissue oxygenation in CKD models.
Pipeline & Workflow Integration
The method fits within the discovery continuum from target validation through preclinical evaluation, offering a bridge between physiological phenotyping and mechanistic insight in renal and cardiovascular disease models.
- Discovery Biology: Supports hypothesis testing of oxygen delivery mechanisms in kidney disease by providing direct tissue oxygenation measurements.
- Screening: Delivers quantitative, real-time outputs that enable comparison of compound or intervention effects on regional oxygen saturation.
- Analytics: Generates rSO2 trends and thresholds that help stratify hemodynamic responses and inform go/no-go decisions.
- Translational Research: Connects acute oxygenation changes during dialysis to chronic tissue injury pathways relevant to CKD progression.
- Enterprise Reuse: Establishes a reusable platform for monitoring tissue oxygenation across disease models, reducing need for redundant assay development.
Operational & Enterprise Impact
- Scientific Value: Reduces mechanistic ambiguity in oxygen-related pathways by delivering direct, organ-specific oxygenation data.
- Operational Value: Ensures standardization and reproducibility through fixed sensor placement and dual-wavelength NIRS measurement.
- Strategic Value: Improves go/no-go decisions by identifying hemodynamic liabilities early, reducing late-stage failure risk.
- Portfolio Impact: Enables risk-adjusted prioritization of compounds based on organ-specific oxygenation safety profiles.
Implementation Considerations
- Requires expertise in near-infrared spectroscopy principles and tissue-specific sensor placement.
- Dependent on NIRS instrumentation with multi-channel capability and dual-wavelength transmission.
- Necessitates standardization of attachment sites (forehead, right hypochondrium, lower legs) and supine positioning protocol.
- Involves validation of signal quality and correction for tissue depth, particularly for hepatic measurements (20–30 mm depth).
- Limited by signal interference from motion, ambient light, or tissue heterogeneity, which must be controlled during monitoring.
