Cognitive impairment in hemodialysis patients is common

Murray, Anne M.; Tupper, David E.; Knopman, David S.; Gilbertson, David T.; Pederson, Sarah; Li, S.; Smith, Glenn E.; Hochhalter, Angela K.; Collins, Allan J.; Kane, Robert L

doi:10.1212/01.wnl.0000225182.15532.40

Cited by 617 publications

(613 citation statements)

References 49 publications

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“…Two recent studies describe the high prevalence of cognitive impairment in CKD and hemodialysis patients (2,10). In a study of CKD and hemodialysis patients by Kurella and colleagues, among 80 hemodialysis patients (mean age 61.2 years), 38 percent had severe impairment in executive function and 33 percent severe memory impairment (10).…”

Section: Prevalence Of Cognitive Impairment In Hemodialysis Patientsmentioning

confidence: 99%

“…Stroke is also 6 to 9 times more common in hospitalized hemodialysis patients than in nondialysis patients (33). A history of stroke doubles the risk of dementia in both the non-CKD and hemodialysis populations (2,14,34) …”

Section: Stroke In the Ckd And Hemodialysis Populations: The Unspokenmentioning

confidence: 99%

“…Delirium is an acute confusional state affecting global cognition that occurs in up to 30 percent of hospitalized elderly (2,51). It is characterized by an acute disturbance of consciousness, with decreased ability to maintain attention; cognitive changes such as memory deficits, disorientation, or language disturbance; reversed sleep-wake cycles; and at times delusions or hallucinations (3).…”

Section: Acute Cognitive Impairment During Dialysis: Deliriummentioning

confidence: 99%

“…For the purposes of this review, severe cognitive impairment will be considered as approximately equivalent to dementia, which per DSM IV criteria is defined as chronic cognitive impairment in two or more cognitive domains that substantially affects daily function, represents a decline in pre-morbid function, and is not due to concomitant acute delirium (2,3) …”

Section: Introductionmentioning

confidence: 99%

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

Murray

2008

Advances in Chronic Kidney Disease

342

241

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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.

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Section: Prevalence Of Cognitive Impairment In Hemodialysis Patientsmentioning

confidence: 99%

Section: Stroke In the Ckd And Hemodialysis Populations: The Unspokenmentioning

confidence: 99%

Section: Acute Cognitive Impairment During Dialysis: Deliriummentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Murray

2008

Advances in Chronic Kidney Disease

342

241

View full text Add to dashboard Cite

show abstract

“…Cognitive impairment is common in patients receiving long-term dialysis 4,5 , leaving families and nephrologists to decide whether and when to withdraw dialysis after patients have lost capacity to decide for themselves. The emotional burden of family decision-making, and the poor concordance between surrogate decisions and patient preferences 6 , raises concerns that some patients may remain on dialysis for longer than they would have chosen.…”

Section: Introductionmentioning

confidence: 99%