ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Renal Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1648608
Hemodialysis-Induced Renal Perfusion Decline: Unraveling the Pathophysiological Mechanisms Linking Intradialytic Circulatory Stress to Residual Renal Function Loss
Provisionally accepted
Dayang Xie1*
Jiaming Tan2Qingtao Zhang3Qian Yu3Yiqin Wang3Yujin Wang3Li Gao3Liyuan Yan3Jianhui Zhou3Nan Li2
GUANGYAN CAI3- 1Department of Anesthesiology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- 2Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing, China
- 3Department of Nephrology, First Medical Center of Chinese PLA General Hospital, beijing, China
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Background: Residual renal function (RRF) plays a critical role in quality of life and survival in hemodialysis (HD) patients but characteristically declines after the initiation of HD. Owing to incomplete understanding of the pathophysiology underlying RRF decline, protective strategies remain limited. The aim of this study was to explore the dynamic changes of renal perfusion in incident HD patients with preserved RRF during dialysis sessions and to provide new strategies for RRF preservation. Methods: This prospective cohort study enrolled 30 incident HD patients with preserved RRF. Renal perfusion was serially assessed using contrast-enhanced ultrasonography (CEUS) at three time points during the HD session: pre-dialysis baseline, intradialytic phase (3 hours post-initiation), and post-dialysis recovery phase (15 minutes after session completion). Renal perfusion was quantified using the CEUS-assessed perfusion index (PI). The primary outcome measure was the PI. Results: During hemodialysis sessions, the PI as a surrogate marker of renal perfusion decreased by 17.53% (P<0.001), which exhibited a negative correlation with ultrafiltration (UF) rates (Spearman's r=−0.770, P<0.001), but not with other variables such as sex, age, body mass index (BMI), blood pressure (BP), estimated glomerular filtration rate(eGFR), hemoglobin, or albumin levels. Conclusions: This study demonstrates that incident HD patients experience an acute decrease in renal perfusion during This is a provisional file, not the final typeset article hemodialysis, which is negatively correlated with mean UF rates. This finding may represent a crucial step toward elucidating the pathophysiology of hemodialysis-mediated RRF decline. Clinical trial registration: Clinical Trials.gov, identifier (NCT07003828).
Keywords: hemodialysis, residual renal function, renal perfusion, Perfusion index, Ultrafiltration
Received: 17 Jun 2025; Accepted: 08 Oct 2025.
Copyright: © 2025 Xie, Tan, Zhang, Yu, Wang, Wang, Gao, Yan, Zhou, Li and CAI. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dayang Xie, 460436948@qq.com
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