Executive function in end-stage renal disease: Acute effects of hemodialysis and associations with clinical factors

Abstract

ObjectiveThere is evidence of cognitive impairment in patients with end-stage renal disease in hemodialysis (ESRD-HD). However, few studies have exhaustively analyzed executive functions (EFs) in this population, especially considering the influence of a wide range of clinical variables. This study analyzes performance in different EF components in ESRD-HD patients compared to a group of healthy controls (HCs), in addition to the acute effects of HD and the associations of cognitive performance with clinical variables.MethodEFs were evaluated pre- and post-HD in 43 ESRD-HD patients and 42 HCs, using a battery of tests designed to assess EF domains. Age, schooling, mood and blood pressure were statistically controlled. Associations between performance and clinical factors were computed by correlations and hierarchical multiple regression analyses.ResultsThe performance of the ESRD-HD patients was significantly lower than that of HCs in all the EF domains except for planning. Group differences were marginally significant for reasoning. HD produced no acute changes in global performance, with improvements see only in inhibition and working memory. EF scores were positively associated with total number of months previously transplanted, body mass index (BMI), dry weight, and levels of hemoglobin, albumin, ferritin, calcium, phosphorus, sodium, urea, and creatinine.ConclusionsGlobal EF functioning was lower in ESRD-HD patients than in HCs. No major acute HD-related EF changes were detected. These findings underline the importance of an adequate nutritional status for maintaining executive functioning in ESRD-HD patients.

Effects of Lower Past‐Year Serum Sodium and Hyponatremia on Depression Symptoms and Cognitive Impairments in Patients With Hemodialysis

“…The literature regarding serum sodium and cognitive impairments in patients with hemodialysis is limited. Our findings on patients with hemodialysis who have low serum sodium levels were consistent with previous studies . One possible mechanism to explain this phenomenon is that cognitive function may deteriorate due to the impairments of neurons caused by uremia, resulting in decreased levels of serum sodium in patients with hemodialysis .…”

Cognitive impairment burden in older and younger adults across the kidney transplant care continuum

“…This study also expands upon prior findings on cognitive function and kidney failure 1,2,21,50 by examining the burden of impairment in executive function by age across the KT care continuum. The substantial burden found among all ages across the care continuum is important to consider in parallel with prior studies that have demonstrated similar findings among hemodialysis patients; about 37% of older patients undergoing hemodialysis had impairment in executive function, 9,34 which amounts to over three times the prevalence found in the general population of older adults aged 65 years and older (5%–10%) 9,51 . Our study supports and expands upon those findings by highlighting the burden among adult candidates of all ages, including among younger age groups 18–64 years of age.…”

Cognitive Dysfunction and Its Risk Factors in Patients Undergoing Maintenance Hemodialysis

“…Sanchez–Fernandez et al used a battery of tests, including the Controlled Oral Word Association Test, the Ruff Figural Fluency Test, the Wechsler Adult Intelligence Scale–III, the Five Digit Test, and the Wisconsin Card Sorting Test, and believed that executive function was lower in patients on MHD than in healthy controls. 16 In this study, the test most commonly used to evaluate executive function was selected, and the results showed that it was lower in patients on MHD in the CI group. The prefrontal cortex and the anterior and posterior cingulate cortices are believed to be linked to executive function, 17 but the causes of CI in patients on MHD need further research.…”