Recognition of Neurocognitive Dysfunction in Chronic Hemodialysis Patients

Kutlay, Sim; Nergızoğlu, Gökhan; Duman, Neval; Atlı, Teslime; Keven, Kenan; Ertürk, Şehsuvar; Ateş, Kenan; Karatan, Oktay

doi:10.1081/jdi-100108189

Cited by 25 publications

(22 citation statements)

References 11 publications

(8 reference statements)

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“…Conclusion: In contrast to several older studies, there is no association between lower other more recent study failed to appreciate a link between dialysis adequacy and cognitive function [16][17][18] . Several of these studies have important limitations: the study of Kutlay et al [16] and colleagues used only the Mini-Mental State Examination (MMSE) for cognitive assessment while Pliskin et al [17] only studied 16 welldialyzed individuals. Tamura et al [18] performed the most current evaluation of this question, using baseline data from the Frequent Hemodialysis Network trials.…”

Section: Introductioncontrasting

confidence: 45%

Cognitive Function and Dialysis Adequacy: No Clear Relationship

Giang¹,

Weiner²,

Agganis³

et al. 2010

Am J Nephrol

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Background/Aims: Cognitive impairment is common in hemodialysis patients and may be impacted by multiple patient and treatment characteristics. The impact of dialysis dose on cognitive function remains uncertain, particularly in the current era of increased dialysis dose and flux. Methods: We explored the cross-sectional relationship between dialysis adequacy and cognitive function in a cohort of maintenance hemodialysis patients. Adequacy was defined as the average of the 3 most proximate single pool Kt/V assessments. A detailed neurocognitive battery was administered during the 1st hour of dialysis. Multivariable linear regression models were adjusted for age, sex, education, race and other clinical and demographic characteristics. Results: Among 273 patients who underwent cognitive testing, the mean (SD) age was 63 (17) years and the median dialysis duration was 13 months, 47% were woman, 22% were African American, and 48% had diabetes. The mean (SD) Kt/V was 1.51 (0.24). In univariate, parsimonious and multivariable models, there were no significant relationships between decreased cognitive function and lower Kt/V. Conclusion: In contrast to several older studies, there is no association between lower Kt/V and worse cognitive performance in the current era of increased dialysis dose. Future studies should address the longitudinal relationship between adequacy of dialysis and cognitive function to confirm these findings.

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Section: Introductioncontrasting

confidence: 45%

Cognitive Function and Dialysis Adequacy: No Clear Relationship

Giang¹,

Weiner²,

Agganis³

et al. 2010

Am J Nephrol

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“…* Denotes p < 0.05. higher serum albumin level, protein catabolic rate, and interdialysis weight gain. 32 Similarly, results from this study showed significant inverse correlations between serum concentrations of albumin, creatinine, calcium and cognitive and motor performance among all study subjects. These inverse correlations with CRD-series test scores indicate improving cognitive and motor performance (lower tests scores in seconds) with increase in laboratory values of albumin, creatinine, and calcium.…”

Section: Discussionmentioning

confidence: 61%

“…39,40 The discovery of the neuroprotective effects of erythropoietin in preclinical studies has been followed by studies in healthy volunteers where erythropoietin was reported to modulate cognitive function-independent of its hematopoietic effects-exerting beneficial effects on memory retrieval, emotional processing, mood, and verbal fluency. 41 Kutlay et al 32 found no relationship between mini mental state exam score and years on dialysis, Kt/V value, hematocrit value, or erythropoietin use in HD patients. Similarly, no relationship between any of the timerelated parameters in CRD-series tests and duration on dialysis, Kt/V, hemoglobin, or weekly dose of erythropoietin was found in HD or CAPD group.…”

Section: Discussionmentioning

confidence: 99%

Is There Differences in Cognitive and Motor Functioning between Hemodialysis and Peritoneal Dialysis Patients?

et al. 2011

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Objective: Change in cognitive function is one of the well-known consequences of the end-stage renal disease (ESRD). The aim of this study was to determine the effect of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on cognitive and motor functions. Methods: In this cross-sectional study, cognitive and motor functions were investigated in a selected population of 42 patients with ESRD (22 patients on chronic HD and 20 patients on CAPD, aged 50.31 ± 11.07 years). Assessment of cognitive and motor functions was performed by Symbol Digit Modalities Test (SDMT) and Complex Reactiometer Drenovac (CRD-series), a battery of computer-generated psychological tests to measure simple visual discrimination of signal location, short-term memory, simple convergent visual orientation, and convergent thinking. Results: The statistically significant difference in cognitive-motor functions between HD and CAPD patients was not found in any of the time-related parameters in all CRD-series tests or SDMT score. Higher serum levels of albumin, creatinine, and calcium were correlated with better cognitive-motor performance among all patients regardless of dialysis modality. The significant correlation between ultrafiltration rate per HD and short-term memory actualization test score (CRD-324 MT) among HD patients was found (r = 0.434, p = 0.025). Conclusion:This study has demonstrated that well-nourished and medically stable HD and CAPD patients without clinical signs of dementia or cognitive impairment and without significant difference in age and level of education performed all tests of cognitive-motor abilities without statistically significant difference.

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“…Other studies have reported mild and moderate to severe mental impairment as measured by the MMSE. [12,13] These findings highlight the need for clinicians to routinely screen hemodialysis patients for mental impairment and develop interventions to improve cognitive status.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Status in Hemodialysis as a Function of Fluid Adherence

2004

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Previous work has shown that dialysis improves cognitive functioning in hemodialysis patients, perhaps due to improvements in anemia among these patients. Such improvements in cognitive performance may lead to better levels of self-care and adherence with treatment. This study examined the relationship between fluid adherence and cognitive functioning in patients receiving hemodialysis. One hundred forty-seven patients were assessed with a brief screening instrument, the Cognistat, to determine their current level of functioning during the first hour of hemodialysis. Fluid nonadherence was operationalized as interdialytic weight gain above 1 kg/day. Rates of impairment on the Cognistat subscale ranged from 2.7% (orientation) to 54% (memory) in this sample. Roughly 68% of the sample was nonadherent during the course of treatment. Results found no differences in mean levels of cognitive performance between those who were adherent and those who were not and only modest relationships of measures of anemia to certain aspects of cognitive performance. For the hemodialysis patient to benefit from self-care education, the patient must be able to understand, remember, reason, and use cognitive processes to modify behavior. These results suggest that more in-depth assessment of cognitive performance may be needed. In addition, this assessment may need to be conducted on a day when treatment is not received.

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Recognition of Neurocognitive Dysfunction in Chronic Hemodialysis Patients

Cited by 25 publications

References 11 publications

Cognitive Function and Dialysis Adequacy: No Clear Relationship

Cognitive Function and Dialysis Adequacy: No Clear Relationship

Is There Differences in Cognitive and Motor Functioning between Hemodialysis and Peritoneal Dialysis Patients?

Cognitive Status in Hemodialysis as a Function of Fluid Adherence

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