Associations of Cognitive Function and Education Level With All-Cause Mortality in Adults on Hemodialysis: Findings From the COGNITIVE-HD Study

Zwieten, Anita van; Wong, Germaine; Ruospo, Marinella; Palmer, Suetonia C.; Teixeira‐Pinto, Armando; Barulli, Maria Rosaria; Iurillo, Annalisa; Saglimbene, Valeria; Natale, Patrizia; Gargano, Letizia; Murgo, Marco; Loy, Clement T.; Tortelli, Rosanna; Craig, Jonathan C.; Johnson, David W.; Tonelli, Marcello; Hegbrant, Jörgen; Wollheim, Charlotta; Logroscino, Giancarlo; Strippoli, Giovanni F.M.; Cagnazzo, A.; Antinoro, R.; Sambati, M; Donatelli, Christopher; Dambrosio, N.; Saturno, C.; Marangelli, A.; Pedone, F.; Matera, Giovanni; Benevento, Marcello; Papagni, Sergio; Alicino, Francesco; Latassa, G.; Molino, Andrea; Grippaldi, F.; Bertino, D.; Montalto, Giuseppe; Messina, Sonia; Campo, Susanna; Nasisi, P.; Failla, A.; Bua, Alessandra; Pagano, Sabrina; Marino, G.; Sanfilippo, Nicholas J; Rallo, D.; Maniscalco, A.; Capostagno, C.; Randazzo, Giorgio; Fici, M.; Lupo, A; Fichera, R.; D’Angelo, Angela; Mammarella, R. Di Toro; Meconizzi, M.; Boccia, Edda; Mantuano, Michele; Flammini, Alessia; Moscardelli, L.

doi:10.1053/j.ajkd.2019.03.424

Cited by 32 publications

(28 citation statements)

References 57 publications

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“…In this study cognitive function has been assessed using a neuropsychological battery of 10 tests. The study showed that cognitive impairment is extremely common in hemodialysis patients with an estimated 71.1% of patients being impaired on at least one domain, and patients often experience multiple deficits simultaneously with 45.2% of patients impaired on two or more domains (30).…”

Section: Functional Brain Damage In Patients With Chronic Kidney Diseasementioning

confidence: 99%

Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients

Miglinas

Cesniene

Janusaite

et al. 2020

Front. Cardiovasc. Med.

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Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.

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Section: Functional Brain Damage In Patients With Chronic Kidney Diseasementioning

confidence: 99%

Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients

Miglinas

Cesniene

Janusaite

et al. 2020

Front. Cardiovasc. Med.

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“…Notably, cognitive impairment (CI) is extremely common in HD patients, across numerous domains, particularly in the domains of orientation and attention and executive function, and patients often experience multiple deficits simultaneously (Drew et al., 2017; O'Lone et al., 2016; van Zwieten et al., 2018). Cognitive deficits are associated with poorer quality of life, risk for hospitalization, and increased mortality in HD patients (Drew et al., 2015; O'Lone et al., 2016; van Zwieten et al., 2019). However, up to now, the underlying pathophysiological mechanisms of CI in HD patients have not been completely clarified.…”

Section: Introductionmentioning

confidence: 99%

Dynamic functional connectivity changes in the triple networks and its association with cognitive impairment in hemodialysis patients

Cao

Liu

et al. 2021

Brain and Behavior

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Introduction: Cognitive impairment is common in hemodialysis (HD) patients; however, the underlying mechanisms have not been fully understood. The "triple-network model" that consists of the salience network (SN), central executive network (CEN), and default mode network (DMN) has been suggested to play an important role in various cognitive functions. However, dynamic functional connectivity (FC) alterations within the triple networks have not been investigated in HD patients.Methods: Sixty-six HD patients and 66 healthy controls (HCs) were included in this study. The triple networks were identified using a group spatial independent component analysis, and dynamic FC was analyzed using a sliding window approach and k-means clustering algorithm. Furthermore, we analyzed the relationships between altered dynamic FC parameters and clinical variables in HD patients. Results:The intrinsic brain FC within the triple networks was clustered into four configuration states. Compared with HCs, HD patients spent more time in State 1, which was characterized by weak connections between the DMN and CEN and SN. HD patients showed lower number of transitions across different states than HCs. Moreover, the number of transitions and mean dwell time in State 1 were associated with cognitive performance in HD patients. Conclusion:Our findings suggest abnormal dynamic FC properties within the triple networks in HD patients, which may provide new insights into the pathophysiological mechanisms of their cognitive deficits from the perspective of dynamic FC.

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“…Recent COGNITIVE-HD studies have also con rmed this phenomenon [26] , therefore, it is urgent to nd effective methods or measures to treat or improve the concurrent CI of MHD. In this study, Kaplan-Meier survival curve analysis indicated that the survival rate in treatment group was signi cantly higher than that in control group.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of thiamine and folic acid in hemodialysis patients with cognitive impairment

Fang

Zhou

et al. 2020

Preprint

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Background: This study aimed to explore the effectiveness of thiamine and folic acid supplementation on the improvement of the cognitive function in patients with maintenance hemodialysis. Methods: In the present study, we randomly assigned patients undergoing hemodialysis who had the Montreal Cognitive Assessment (MoCA) score lower than 26 to treatment group (n=25, thiamine 90mg/day combined with folic acid 30mg/day) or control group (n=25, nonintervention). All subjects were followed up for 96 weeks. The primary outcome was the improvement of the MoCA score. The secondary outcomes included homocysteine level, survival and safety. Results: Patients in treatment group had an increase of the MoCA score from 21.95±3.81 at baseline to 25.68±1.96 at week 96 (P<0.001, primary outcome), as compared with the MoCA score from 20.69±3.40 to 19.62±3.58 in control group. Thiamine combined with folic acid treatment also resulted in lower level of serum homocysteine in treatment group compare with control group at week 96 (P<0.05, secondary outcome). 3 patients and 9 patients died during follow-up period in treatment and control group respectively (P=0.048). The proportion of adverse events in treatment group was significantly lower than that in control group. Conclusion: Hemodialysis patients with cognitive impairment treated with thiamine and folic acid had a significant improvement in MoCA score. Trial registration: Clinical trial registration number: ChiCTR-IPR-17012210.

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Associations of Cognitive Function and Education Level With All-Cause Mortality in Adults on Hemodialysis: Findings From the COGNITIVE-HD Study

Cited by 32 publications

References 57 publications

Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients

Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients

Dynamic functional connectivity changes in the triple networks and its association with cognitive impairment in hemodialysis patients

A pilot study of thiamine and folic acid in hemodialysis patients with cognitive impairment

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