Cognitive performance in dialysis patients - "when is the right time to test?"

Published on Jun 2, 2021in BMC Nephrology1.913
· DOI :10.1186/S12882-021-02333-X
Hristos Karakizlis (University of Marburg), Stefanie Thiele (University of Marburg)+ 1 AuthorsJoachim Hoyer34
Estimated H-index: 34
(University of Marburg)
Source
Abstract
BACKGROUND Cognitive impairment in chronic kidney disease, especially in end stage renal disease, is a public health problem. Nevertheless, the cause of chronic kidney disease still remains unclear. A prevalence of cognitive impairment in patients with end stage renal disease of up to 87% has been found. METHODS The study at hand deals with the research on the - potential - effect of timing on cognitive performance when testing cognitive impairment in hemodialysis patients during the dialysis cycle. We tested cognitive performance with a neuropsychological test battery (RBANS, Repeatable Battery for the Assessment of Neuropsychological Status) on two occasions while patients were on dialysis as well as on a dialysis-free day. In addition, all participants were rated using the Geriatric Depression Scale (GDS) and several demographic and clinical variables were recorded in order to investigate their possible influence on cognitive performance. The patients were recruited in three dialysis centers in the central region of Hesse, Germany. Twenty-six participants completed the 3 testings during a period of 6 weeks. The testing was carried out in the dialysis centers. RESULTS Looking at the total scale score, patients achieved the best cognitive performance in the RBANS during the first 2 h on dialysis with 81.1 points. When comparing the scores of the three measurement occasions (first 2 h, Timepoint 1 vs. last 2 h, Timepoint 2 vs. dialysis free day, Timepoint 3, however, no significant difference in the total scale score was detected. But patients showed significantly better cognitive performance in language in the first 2 h (p < 0.001) as well as in the last 2 h (p < 0.001) compared with the dialysis-free day. CONCLUSION Due to the high prevalence of cognitive impairment, there is an increasing need to assess cognitive function in dialysis patients. Our data show that the time point of testing (first 2 h on hemodialysis vs. last 2 h on hemodialysis vs. Hemodialysis free day) had no influence of cognitive function in hemodialysis patients in routine indications.
References0
Newest
#1Mark Findlay (Glas.: University of Glasgow)H-Index: 7
#2Jesse Dawson (Glas.: University of Glasgow)H-Index: 37
Last. Patrick B. Mark (Glas.: University of Glasgow)H-Index: 37
view all 7 authors...
Background The immediate and longer-term effects of hemodialysis on cerebral circulation, cerebral structure, and cognitive function are poorly understood. Methods In a prospective observational cohort study of 97 adults (median age 59 years) receiving chronic hemodialysis, we used transcranial Doppler ultrasound to measure cerebral arterial mean flow velocity (MFV) throughout dialysis. Using a well validated neuropsychological protocol, we assessed cognitive function during and off dialysis and...
38 CitationsSource
#1Indranil DasguptaH-Index: 30
#2Mitesh PatelH-Index: 2
Last. George TadrosH-Index: 10
view all 7 authors...
INTRODUCTION Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. METHODS All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Asses...
9 CitationsSource
#1David A. Drew (Tufts Medical Center)H-Index: 53
#2Daniel E. Weiner (Tufts Medical Center)H-Index: 60
Last. Mark J. Sarnak (Tufts Medical Center)H-Index: 108
view all 7 authors...
Background Cognitive impairment is common in patients treated with hemodialysis. The trajectory of cognitive function and risk factors for cognitive decline remain uncertain in this population. Study Design Longitudinal cohort. Setting & Participants 314 prevalent hemodialysis patients. Predictors Age, sex, race, education level, hemodialysis vintage, cause of end-stage renal disease, and baseline history of cardiovascular disease. Outcomes Cognitive function as determined by a comprehensive neu...
32 CitationsSource
#1Kyoko MaesatoH-Index: 15
#2Takayasu OhtakeH-Index: 19
Last. Shuzo KobayashiH-Index: 28
view all 8 authors...
Background Cognitive impairment is one of the important critical issues in hemodialysis (HD) patients. However, the associating factors of brain atrophy in HD patients have not been fully elucidated. Purpose and methods Brain magnetic resonance imaging (MRI) was performed in 34 of total 72 HD outpatients in our dialysis center. These MRI images were analyzed by an application software; Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD). VSRAD quantitatively calculates ...
5 CitationsSource
#1Clare MacEwen (National Health Service)H-Index: 5
#2Sheera Sutherland (National Health Service)H-Index: 3
Last. Lionel TarassenkoH-Index: 66
view all 5 authors...
The relationship between BP and downstream ischemia during hemodialysis has not been characterized. We studied the dynamic relationship between BP, real-time symptoms, and cerebral oxygenation during hemodialysis, using continuous BP and cerebral oxygenation measurements prospectively gathered from 635 real-world hemodialysis sessions in 58 prevalent patients. We examined the relationship between BP and cerebral ischemia (relative drop in cerebral saturation >15%) and explored the lower limit of...
53 CitationsSource
Background: Cognitive impairment in end-stage kidney disease patients on dialysis is increasingly common. This study aimed to review the practice of screening and
7 CitationsSource
#1Emma O'Lone (USYD: University of Sydney)H-Index: 15
#2Michael H. ConnorsH-Index: 19
Last. Angela C. Webster (USYD: University of Sydney)H-Index: 70
view all 12 authors...
Background Cognitive impairment is associated with poorer quality of life, risk for hospitalization, and mortality. Cognitive impairment is common in people with end-stage kidney disease treated with hemodialysis, yet the severity and specific cognitive deficits are uncertain. Study Design Systematic review and meta-analysis. Setting & Population Adults receiving hemodialysis compared with the general population, people with non−dialysis-dependent chronic kidney disease (NDD-CKD), people receivi...
77 CitationsSource
#1Hai-Chen Pi (PKU: Peking University)H-Index: 2
#2Yu-Feng XuH-Index: 1
Last. Jie DongH-Index: 18
view all 8 authors...
Background/Aims: Cognitive impairment and abnormal structural neuroimaging is common in chronic kidney disease patients. We aimed to explore its association with
16 CitationsSource
#1Sabrina M. Schneider (MHH: Hannover Medical School)H-Index: 3
#2Anne K. Malecki (MHH: Hannover Medical School)H-Index: 1
Last. Jan T. Kielstein (MHH: Hannover Medical School)H-Index: 65
view all 10 authors...
Background. Cognitive function declines in parallel to the decrease in glomerular filtration rate, best epitomized by the markedly reduced cerebral performance in patients undergoing maintenance haemodialysis [chronic kidney disease stage 5 dialysis (CKD5D)]. Aside from structural permanent damage, there seems to be a reversible part of low cognitive performance. The potential effect of a single dialysis session on cognitive function remains still elusive. The aim of the study was to assess cogn...
26 CitationsSource
#1Taimur Dad (Tufts Medical Center)H-Index: 7
#2Daniel E. Weiner (Tufts Medical Center)H-Index: 60
Cerebrovascular disease and stroke are very common at all stages of chronic kidney disease (CKD), likely representing both shared risk factors as well as synergy among risk factors. More subtle ischemic brain lesions may be particularly common in the CKD population, with subtle manifestations including cognitive impairment. For individuals with nondialysis CKD, the prevention, approach to, diagnosis, and management of stroke is similar to the general, non-CKD population. For individuals with end...
39 CitationsSource
Cited By0
Newest