Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery

Stefanidis, Ioannis; Bach, R.G.; Mertens, Peter R.; Liakopoulos, V.; Liapi, G.; Mann, H.; Heintz, Bernhard

doi:10.5414/cnp64129

Cited by 66 publications

(75 citation statements)

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“…18,21 Acute effects of the hemodialysis procedure, such as reductions in cerebral blood flow, have been suggested to correlate with stroke in some studies. 22,23 Medications administered during hemodialysis, such as anticoagulants or erythropoiesis stimulating agents, may also contribute to stroke risk in patients with ESRD. 24,25 With the exception of nonwhite race and preexisting cardiovascular disease, we did not find differences in clinical characteristics among ESRD participants with vs without prior stroke or TIA, or among ESRD participants with vs without stroke symptoms.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

et al. 2012

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Objective: The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA. Methods:We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.Results: Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p Յ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03-5.92) and IADL impairment (OR 3.86, 95% CI 1.60-9.28).Conclusions: Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population. Neurology ® 2012;79:981-987

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Section: Discussionmentioning

confidence: 99%

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

et al. 2012

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“…Rapid fluctuations in blood pressure, the removal of large fluid volumes, and hemoconcentration increase the risk of inducing cerebral hypoperfusion (58). The recent use of high flux dialysis membranes enables shorter sessions for a given prescribed dose, but also increases the potential for more rapid osmotic shifts.…”

Section: Acute Cognitive Impairment During Dialysis: Deliriummentioning

confidence: 99%

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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“…HD patients are also at higher risk of hospitalization for psychiatric illness (30). By contrast, PD patients have greater stability in intracranial pressure and cerebral blood flow due to smaller changes in urea clearance, acid-base status, serum osmolality, and fluid status (31,32). Fewer fluid shifts in PD also contribute to fewer changes in brain volume.…”

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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Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery

Cited by 66 publications

References 0 publications

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

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

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

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