Acute Variation in Cognitive Function in Hemodialysis Patients: A Cohort Study With Repeated Measures

Murray, Anne M.; Pederson, Sarah; Tupper, David E.; Hochhalter, Angela K.; Miller, Wendy A.; Li, Qi; Zaun, David; Collins, Allan J.; Kane, Robert L; Foley, Robert N.

doi:10.1053/j.ajkd.2007.05.010

Cited by 110 publications

(104 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that cerebral function declined acutely during dialysis (25). The acute fluid shifts and intravascular volume loss that occur during dialysis induce cerebral edema and decreased intra-cerebral blood pressure, blood velocity and cerebral perfusion (76)(77)(78).…”

Section: The Dialysis Process and Cognitive Impairmentmentioning

confidence: 84%

“…However, in contrast to the general population, the roles of aging and non-vascular factors are overshadowed by stroke and the high prevalence of cardiovascular risk factors (18)(19)(20). In addition, the contributions of factors secondary to kidney failure such as uremia, anemia, metabolic disturbances and hemodynamic instability during dialysis are still to be defined (4,25). In the Health ABC study, CKD accounted for approximately 10 percent of the cognitive impairment risk that was unexplained by demographic factors and comorbidities (26).…”

Section: Risk Factors For Cognitive Impairment In Hemodialysis Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

Self Cite

342

241

View full text Add to dashboard Cite

The heavy burden of cognitive impairment in hemodialysis and chronic kidney disease patients has only recently become recognized. Up to 70 percent of hemodialysis patients ages 55 years and older have moderate to severe chronic cognitive impairment, yet it is largely undiagnosed. Recent studies describe the strong graded relation between estimated glomerular filtration rate (eGFR) and cognitive function in CKD patients. The process of conventional hemodialysis may induce recurrent episodes of acute cerebral ischemia, which in turn may contribute to acute decline in cognitive function during dialysis. Thus the worst time to communicate with dialysis patients may be during the hemodialysis session. Both symptomatic and occult, subclinical ischemic cerebrovascular disease appear to play a large role in a proposed model of accelerated vascular cognitive impairment in these populations. Severe cognitive impairment or dementia among hemodialysis patients is associated with an approximately two-fold increased risk of both mortality and dialysis withdrawal. Pre-dialysis cognitive screening and adding dementia to the list of comorbidities on Form 2728 would provide critical information regarding the benefit versus risks of receiving dialysis. It could also improve quality of care and outcomes by raising clinician's awareness of the potential effects of cognitive impairment on medication, fluid, and dietary compliance, and ability to make advance directive decisions among dialysis patients. While much remains to be learned regarding the pathophysiology of cognitive impairment in kidney disease, the public health implications of this substantial burden are immediate.

show abstract

Section: The Dialysis Process and Cognitive Impairmentmentioning

confidence: 84%

Section: Risk Factors For Cognitive Impairment In Hemodialysis Patientsmentioning

confidence: 99%

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

Self Cite

342

241

View full text Add to dashboard Cite

show abstract

“…Second, repeated rapid removal of solutes might have previously unappreciated cumulative detrimental effects on cognition. For example, there is evidence that the process of dialysis produces transient cognitive deficits (29). Third, patients with a smaller ultrafiltration volume may be at independent risk for cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients

Tamura

Larive²,

Unruh³

et al. 2010

Clinical Journal of the American Society of Nephrology

176

151

View full text Add to dashboard Cite

Background and objectives: Cognitive impairment is common among persons with ESRD, but the underlying mechanisms are unknown. This study evaluated the prevalence of cognitive impairment and association with modifiable ESRD-and dialysis-associated factors in a large group of hemodialysis patients.Design, setting, participants, & measurements: Cross-sectional analyses were conducted on baseline data collected from 383 subjects participating in the Frequent Hemodialysis Network trials. Global cognitive impairment was defined as a score <80 on the Modified Mini-Mental State Exam, and impaired executive function was defined as a score >300 seconds on the Trailmaking B test. Five main categories of explanatory variables were examined: urea clearance, nutritional markers, hemodynamic measures, anemia, and central nervous system (CNS)-active medications.Results: Subjects had a mean age of 51.6 ؎ 13.3 years and a median ESRD vintage of 2.6 years. Sixty-one subjects (16%) had global cognitive impairment, and 110 subjects (29%) had impaired executive function. In addition to several nonmodifiable factors, the use of H1-receptor antagonists and opioids were associated with impaired executive function. No strong association was found between several other potentially modifiable factors associated with ESRD and dialysis therapy, such as urea clearance, proxies of dietary protein intake and other nutritional markers, hemodynamic measures, and anemia with global cognition and executive function after adjustment for case-mix factors.Conclusions: Cognitive impairment, especially impaired executive function, is common among hemodialysis patients, but with the exception of CNS-active medications, is not strongly associated with several ESRD-and dialysis-associated factors.

show abstract

“…The dialysis unit can be a noisy environment potentially leading to distractions and the dialysis procedure itself could possibly lead to delirium that affects performance on cognitive tests. [28][29][30][31][32][33] However, we have recently demonstrated that cognitive performance is not affected by the time of testing. In a randomized crossover study of 40 patients, performance on cognitive testing was no different 1 hour before dialysis vs the first hour of the dialysis treatment.…”

mentioning

confidence: 99%

Frequency of and risk factors for poor cognitive performance in hemodialysis patients

Sarnak¹,

Tighiouart²,

Scott³

et al. 2013

Neurology

206

186

View full text Add to dashboard Cite

Objective: There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing.Methods: In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwent detailed cognitive assessment. The neuropsychological battery assessed a broad range of functions, with established age-, sex-, and education-matched normative scores. Principal component analysis was used to derive composite scores for memory and executive function domains. Risk factors for each domain were evaluated using linear regression adjusting for age, sex, race, and education status. Analyses were repeated in those with Mini-Mental State Examination (MMSE) score $24.Results: Compared with population norms, patients on dialysis had significantly poorer executive function but not memory performance, a finding that persisted in the subgroup with MMSE score $24. In adjusted analyses, vascular risk factors and vascular disease were associated with lower executive function (p , 0.01).Conclusions: There is a high frequency of poor cognitive performance in hemodialysis patients, primar- Cognitive impairment in dialysis is an increasingly important public health problem given the aging end-stage renal disease (ESRD) population and the increasing prevalence of diabetes and vascular disease. In older studies in hemodialysis patients, cognitive impairment, defined by poor performance on the Mini-Mental State Examination (MMSE), was present in 40% to 60%. 1-3 Despite the fact that the MMSE remains the most frequently used screening tool for cognitive impairment, it focuses on memory and largely neglects other cognitive domains such as executive function; accordingly, the MMSE may not be sufficient to detect more subtle degrees of cognitive impairment.The major causes of dementia in the general population are Alzheimer disease, which initially manifests with memory loss with later involvement of other cognitive domains, and vascular dementia, which primarily manifests with impairment in executive function. [4][5][6][7] Although it is likely that patients undergoing dialysis have similar causes for cognitive impairment as the general population, there are few studies that have attempted to distinguish the prevalence of and risk factors for each type of cognitive impairment in this population.The goals of this study were therefore to evaluate the frequency of and risk factors for poor cognitive performance in hemodialysis patients using detailed measures of multiple cognitive domains, From the Division of Nephrology (M.J.S., K

show abstract

Acute Variation in Cognitive Function in Hemodialysis Patients: A Cohort Study With Repeated Measures

Cited by 110 publications

References 19 publications

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients

Frequency of and risk factors for poor cognitive performance in hemodialysis patients

Contact Info

Product

Resources

About