Renal and segmental artery hemodynamic response to acute, mild hypercapnia

摘要

Profound increases (>15 mmHg) in arterial carbon dioxide (i.e., hypercapnia) reduce renal blood flow. However, a relatively brief and mild hypercapnia can occur in patients with sleep apnea or in those receiving supplemental oxygen therapy during an acute exacerbation of chronic obstructive pulmonary disease. We tested the hypothesis that a brief, mild hypercapnic exposure increases vascular resistance in the renal and segmental arteries. Blood velocity in 14 healthy adults (26 ± 4 yr; 7 women, 7 men) was measured in the renal and segmental arteries with Doppler ultrasound while subjects breathed room air (Air) and while they breathed a 3% CO_2, 21% O_2, 76% N_2 gas mixture for 5 min (CO_2). The end-tidal partial pressure of CO_2 (Pet_(CO_2)) was measured via capnography. Mean arterial pressure (MAP) was measured beat to beat via the Penaz method. Vascular resistance in the renal and segmental arteries was calculated as MAP divided by blood velocity. Pet_(CO_2) increased with CO_2 (Air: 45 ± 3, CO_2: 48 ± 3 mmHg, P < 0.01), but there were no changes in MAP (P = 0.77). CO_2 decreased blood velocity in the renal (Air: 35.2 ± 8.1, CO_2: 32.2 ± 7.3 cm/s, P < 0.01) and segmental (Air: 24.2 ±5.1, CO_2: 21.8 ± 4.2 cm/s, P < 0.01) arteries and increased vascular resistance in the renal (Air: 2.7 ± 0.9, CO_2: 3.0 ± 0.9 mmHg-cm~(-1), P < 0.01) and segmental (Air: 3.9 ± 1.0, CO_2: 4.4 ± 1.0 mmHg-cm~(-1), P < 0.01) arteries. These data provide evidence that the kidneys are hemodynamically responsive to a mild and acute hypercapnic stimulus in healthy humans.