Does hemodialysis hurt the brain?

Dialysis patients have a high prevalence of both structural brain abnormalities and cognitive impairment. The pathogenesis of the structural brain abnormalities and cognitive impairment as well the relationship between the two is however less clear. In this editorial, we question whether the hemodialysis procedure itself may be partly responsible for the structural abnormalities noted on imaging studies as well as for the cognitive impairment. We invoke several mechanisms whereby the procedure itself may "hurt" the brain including rapid changes in blood pressure, microembolization, microbleeds, and cerebral edema. We then summarize research questions whose answers may help move the field forward.