Cognitive Function Declines Significantly during Haemodialysis in a Majority of Patients: A Call for Further Research

Abstract

Introduction: Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. Methods: All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. Results: Eight-two patients completed both tests – median age 73 (52–91) years, 59% male, dialysis vintage 41 (3–88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. Conclusion: Cognitive function declines over a haemodialysis session and this has significant clinical implications over health literacy, self-management and tasks like driving. More research is needed to find the cause for this decline in cognition.

Effect of a Single Dialysis on Cognitive Function in Chronic Kidney Disease Stage 5 Hemodialysis Patients

“…Consistent with Dasgupta et.al who reported 76% patients had at least mild CI at the start of HD session and 15% had severe CI. 20 In this study, we found a significant decline of cognitive function during HD in majority of patients as seen from MoCA INA score (21,65 ± 5,32 to 19,67 ± 4,82, p < 0.001) and also 11 out of 16 patients (68.8%) whose cognition changed from normal to abnormal during HD (p < 0.001). A single HD session lead to cognitive improvement as seen from MoCA INA score (21,65 ± 5,32 to 19,67 ± 4,82 to 23,65 ± 5,38, p < 0.001) and also 7 out of 44 patients (15.9%) whose cognition changed from abnormal to normal after HD (p < 0.001).…”

“…22,23 Hemodynamic stress during HD lead to temporary deterioration of cognitive function which subsequently improves several hours after HD as an effect of uremic toxin elimination. 20,22,24 Hemodynamic stress during HD will be transmitted to and causes dysregulation of cerebral circulation. 20,25 Fluid and electrolyte shift, intravascular volume loss during HD can also cause brain edema, decreased intracerebral pressure and perfusion to brain.…”

“…20,22,24 Hemodynamic stress during HD will be transmitted to and causes dysregulation of cerebral circulation. 20,25 Fluid and electrolyte shift, intravascular volume loss during HD can also cause brain edema, decreased intracerebral pressure and perfusion to brain. 9,26 And in the end, transient cerebral injury that occurs continuously will contribute to long-term CI in HD patients.…”

The Incidence Prognosis and Risk Factors of Cognitive Impairment in Maintenance Haemodialysis Patients

“…Notably, it is not only associated with patient's quality of life but also closely related with the clinical prognosis. Due to the concealment clinical symptoms, the overall prevalence of CI in MHD patients is increasing and has been estimated at 30-60% [12][13][14][15]. However, the call for early detection of CI in patients with MHD has yet to be translated to every-day clinical practice.…”

“…In this study, 51.6% of patients presented with CI (defined according to MoCA score) in MHD patients. Recently, the study performed by Dasgupta et al [15] showed that the cognitive function declines in MHD patients and this has significant clinical implications over health literacy, self-management and tasks like driving. The authors call for further research to find the cause for this decline in cognition.…”