Haemodynamics during dialysis and cognitive performance

Wolfgram, Dawn; Sunio, Lily; Vogt, Elisabeth M.; Smith, Heather; Visotcky, Alexis; Laud, Purushottam W.; Whittle, Jeff

doi:10.1111/nep.12324

Cited by 12 publications

(15 citation statements)

References 24 publications

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“…Frequent hemodialysis schedules almost certainly reduce hemodynamic and osmotic stress, but have not been found to impact on cognitive function . Two very different cross‐sectional studies found no association between any domain of cognitive function and intra‐dialytic hemodynamics . The larger study, in 383 patients, did not gather hemodynamic information, but used receipt of intra‐dialytic fluid bolus in the week preceding cognitive testing as a surrogate for propensity to severe hypotension .…”

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confidence: 99%

“…The larger study, in 383 patients, did not gather hemodynamic information, but used receipt of intra‐dialytic fluid bolus in the week preceding cognitive testing as a surrogate for propensity to severe hypotension . In contrast, Wolgram et al averaged NIBP indices from 12 consecutive sessions in a small cohort of 32 patients . The same 32 patients were reassessed after 12 months: there was no relationship between change in cognitive function and typical intra‐dialytic hemodynamics, assessed from 15 sample sessions over the year …”

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confidence: 99%

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Cerebral ischemia during hemodialysis—finding the signal in the noise

MacEwen

Watkinson

Tarassenko

et al. 2018

Seminars in Dialysis

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Hemodialysis patients have multiple risk factors for small vessel cerebrovascular disease and cognitive dysfunction. Hemodialysis itself may cause clinically significant neurological injury through repetitive cerebral ischemia. However, supporting evidence to date consists of epidemiological associations, expert opinion, and small, single-centre studies of variable methodological quality. Isolating the impact of intra-dialytic hemodynamic instability from underlying renal and vascular disease on clinically relevant functional outcomes would require very large, controlled studies, given the heterogeneity and confounding comorbidities of the population, and the complex relationship between blood pressure and cerebral oxygen delivery. There has been an increase in complementary physiological studies looking directly at intra-dialytic cerebral oxygen balance, which have provided supporting evidence for the occurrence of cerebral ischemia, often independently of hemodynamics. Data suggesting a relationship between these measures of oxygen balance and functional outcomes is only hypothesis-generating at this stage. We advocate the testing of interventions that aim to reduce intra-dialytic cerebral hypoxia (rather than hypotension) in sufficiently powered studies, followed by correlation with validated, longitudinal assessment of clinically relevant neurological damage.

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confidence: 99%

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confidence: 99%

Cerebral ischemia during hemodialysis—finding the signal in the noise

MacEwen

Watkinson

Tarassenko

et al. 2018

Seminars in Dialysis

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“…The MoCA for a cut-off value of ≤24 out of 30 was found to be more sensitive and specific in screening for cognitive impairment, with a sensitivity of 76.7% and a specificity of 78.6%, compared to the MMSE for a cut-off value of ≤24 out of 30, with a sensitivity of 55.2% and a specificity of 75.0%. In one study, 66% of haemodialysis patients had moderate to severe cognitive impairment based on neuropsychological testing, and 59% of patients scored two standard deviations below the mean on the MoCA [53]. A cross-sectional study of cognitive function in 374 haemodialysis patients aged ≥55 years found a prevalence of cognitive impairment in 87.3% based on neuropsychological testing and in 40.5% based on the 3MS [36].…”

Section: Resultsmentioning

confidence: 99%

“…There were 46 studies meeting the inclusion criteria for final analysis [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. An overview of the reviewed articles is presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

San

Hiremagalur

Muircroft

et al. 2017

Dement Geriatr Cogn Disord

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Background: Cognitive impairment in end-stage kidney disease patients on dialysis is increasingly common. This study aimed to review the practice of screening and to evaluate the evidence on cognitive impairment prevalence in this population. Methods: This scoping review of studies summarises the evidence on cognitive impairment in dialysis populations. The search included the Medline, CINAHL, Embase, PsycINFO, PubMed, and Cochrane Library databases for English-language articles published between 2000 and 2015. A total of 46 articles were reviewed. Results: The studies were of prospective observational design, with the majority conducted in the haemodialysis population. The reported prevalence of cognitive impairment ranged from 6.6 to 51%. Three screening tools were consistently used. Conclusion: While cognitive impairment is recognised in the dialysis population, there is paucity of screening data. The design of prospective comparisons ideally includes established screening instruments, particularly the Montreal Cognitive Assessment, to determine the optimal results for this population. Translation of established screening tools to increase the inclusion of people from other cultural and language groups is required. Regular screening can enhance the timing to introduce home-based care support and advance care planning discussions.

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“…A significant increase in dementia prevalence has been observed within the 2 years immediately following the initiation of HD and small studies have also demonstrated that HD patients have more rapid decline in cognitive test scores than age-matched controls [13]. Severe CI or dementia is associated with approximately twofold increased mortality in these patients [5].…”

Section: Introductionmentioning

confidence: 99%

Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients

Kovářová¹,

Valeriánová²,

Kmentova³

et al. 2018

Nephron

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Background/Aims: High rates of cognitive impairment (CI) are an alarming problem in patients undergoing chronic hemodialysis (HD). Its pathophysiology remains unclear and there are indications that brain ischemia might be one of the key causes. Cerebral tissue oxygenation, as measured by near-infrared spectroscopy, is known to be decreased in HD patients. However, it is unknown whether CI is associated or not associated with lower cerebral oxygenation in these patients. The primary aim of our study was to probe this possible association. Our secondary aim was to assess other factors possibly related to cerebral ischemia and CI. Methods: Thirty-nine patients treated by chronic HD were included in this cross-sectional study. All measurements were performed before the initiation of an HD session. The Montreal Cognitive Assessment (MoCA) was administered according to published recommendations. Regional saturation of oxygen (rSO2) of the left frontal lobe was measured using the INVOS 5100C device. Basic medical history and laboratory data were recorded, and handgrip strength was analyzed. We used the unpaired t test to compare the rSO2 and other variables between cognitively normal patients (MoCA score ≥26) and those who displayed CI (MoCA score <26). Multiple linear regression analysis was used to adjust for principal confounders. Results: Cognitively impaired patients had lower brain rSO2 values compared to cognitively normal patients (48 ± 9 vs. 57 ± 10%, p = 0.01). Among other variables, higher red cell distribution width (15.8 ± 1.9 vs. 13.8 ± 1.6%, p = 0.01) and lower hand grip strength (49.2 ± 23.3 vs. 99.3 ± 31.4 lbs, p < 0.001) also displayed a significant association with CI. The relation between rSO2 and MoCA score was significant after adjustment for age and gender (p = 0.007). Conclusion: Decreased brain oxygenation is associated with weaker cognitive performance in patients undergoing chronic HD. Further understanding the causes of cerebral ischemia in HD patients could lead to the prevention of cognitive decline in this population.

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Haemodynamics during dialysis and cognitive performance

Cited by 12 publications

References 24 publications

Cerebral ischemia during hemodialysis—finding the signal in the noise

Cerebral ischemia during hemodialysis—finding the signal in the noise

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients

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