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

Abstract

Background: The incidence of cognitive impairment (CI) has been widely reported in various studies among chronic kidney disease (CKD) patients. Many factors influence cognitive function including the hemodialysis (HD) process itself. There is much evidence that a single HD session brings about changes in the cognitive status of patients, but just a few studies assessing whether cognitive performance varies with dialysis. Aim:To know the effect of single dialysis session on cognitive function in HD patients. Method:Sixty medically stable CKD stage 5 patients on HD maintenance for at least three months were enrolled. Cognitive testing performed thrice, 1-2 hour prior to dialysis (T1), 3-4 hour into the session (T2) and 24 hour after the session (T3) using a wellvalidated neuropsychological test battery, Montreal Cognitive Assessment (MoCA) Indonesian version which assess the domain of cognitive function including visuospatial, executive function, naming, memory, attention, language, abstraction, recall, and orientation.Result: Subjects' mean age was 45,45 ± 11,28 years, dialysis vintage 10,12 ± 11,88 months, 44 patients (73,3%) had CI at baseline. Cognitive function decline during dialysis (T2) (MoCA INA score 21,65 to 19,67, p < 0.001) and visuospatial, executive function, attention, language and recall was impaired during dialy-sis. Cognitive function reached its best 24 hour after dialysis (MoCA INA score 23,65, p < 0.001) and all the domain of cognitive function was improved except naming that didn't change over the dialysis session. Conclusion:There is an effect of single HD session on global cognitive function where executive function, attention, language, and recall deteriorated during HD while abstraction and orientation didn't change. All cognitive domains were recovered 24 hours after HD except naming that didn't change from baseline throughout the whole process.