Dialysis-Related Hypotension as a Cause of Progressive Frontal Lobe Atrophy in Chronic Hemodialysis Patients: A 3-Year Prospective Study

Mizumasa, Tohru; Hirakata, Hideki; Yoshimitsu, Takahiro; Hirakata, Eriko; Kubo, Michiaki; Kashiwagi, Masahide; Tanaka, Hiroshi; Kanai, Hidetoshi; Fujimi, Satoshi; Iida, Mitsuo

doi:10.1159/000077592

Cited by 97 publications

(67 citation statements)

References 22 publications

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“…IDH is an independent risk factor for mortality in patients on hemodialysis [5,6] and may negatively affect their quality of life [7] . It is also associated with increased morbidity including frontal lobe atrophy [8] , myocardial injury [9] , and mesenteric ischemia [10] . Nephrologists employ various methods on dialysis to minimize IDH including sodium modeling, ultrafiltration profiling, addition of calcium or bicarbonate to the dialysate bath, and dialysate cooling.…”

Section: Introductionmentioning

confidence: 99%

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Toth‐Manikowski

Sozio

2016

WJN

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The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension (IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst incenter hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 ℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here. Core tip: Cooled dialysate is commonly employed to reduce the incidence of intradialytic hypotension (IDH) in patients on chronic dialysis. The studies to date that have evaluated cooled dialysate are limited by small sample size and it has not become the standard of care for managing IDH. However, the small studies that exist are promising and suggest that cooling dialysate improves hemodynamic tolerability of dialysis, minimizes IDH, and exerts a protective effect over major organs including the heart and brain. More studies are needed to assess the long-term effects of cooling dialysate in this population.Toth-Manikowski SM, Sozio SM. Cooling dialysate during incenter hemodialysis: Beneficial and deleterious effects. World J Nephrol 2016; 5(2): 166-171 Available from:

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Section: Introductionmentioning

confidence: 99%

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Toth‐Manikowski

Sozio

2016

WJN

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“…For example, in the National Cooperative Dialysis Study, higher levels of urea clearance were correlated with better cognitive performance (7). In addition, cardiovascular and hemodynamic factors (hypertension, and at the other extreme, intradialytic hypotension) may lead to stroke or cerebral ischemia and contribute to cognitive impairment in patients with ESRD (8,9). Anemia has also been associated with poor cognitive function and dementia (1,10).…”

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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

177

151

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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.

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“…Cortical atrophy in HD patients may be related to repeated hypotensive episodes (26). Cognitive impairment, including dementia, is also prevalent in patients with ESRD and affects 16%-38% of patients (27).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

Wang

Cheng

Lin

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives This study compared the risk of subdural hematoma (SDH) and subsequent mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients with ESRD.Design, setting, participants, & measurements Claims data were obtained from the National Health Insurance Administration Research Database in Taiwan. This retrospective cohort study comprised 10,136 PD patients and 10,136 HD patients with newly diagnosed ESRD from 1998 to 2010. Patients were matched by propensity score and year of dialysis initiation. Incidence rates and hazard ratios of SDH as well as odds ratios of subsequent 30-day deaths from SDH were evaluated from the date of the first dialysis session to the date when SDH was diagnosed, or the date of renal transplantation, death, withdraw from insurance, or the end of the follow-up period (December 31, 2011).Results Median (25th percentile, 75th percentile) follow-up times for SDH events were 3.61 years (1.91, 6.33) and 3.33 years (1.83, 5.66) in the HD and PD cohorts, respectively. The overall SDH incidence rate (95% confidence interval [95% CI]) was 61.4% higher in the HD cohort than in the PD cohort (34. Conclusions HD patients have a higher risk of developing SDH than PD patients. Both patient groups have a high risk of mortality. Routine education on fall prevention is needed for dialysis patients.

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Dialysis-Related Hypotension as a Cause of Progressive Frontal Lobe Atrophy in Chronic Hemodialysis Patients: A 3-Year Prospective Study

Cited by 97 publications

References 22 publications

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

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