Ana S Costa1, Frances E Tiffin-Richards1, Bernhard Holschbach2, Rolf D Frank3, Athina Vassiliadou4, Thilo Krüger5, Frank Eitner6, Theresa Gross7, Nadim J Shah8, Jörg B Schulz1, Jürgen Floege9, Kathrin Reetz10. 1. Department of Neurology, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany; Jülich Aachen Research Alliance (JARA)-Translational Brain Medicine, Aachen and Jülich, Germany. 2. KfH Kuratorium für Dialyse und Nierentransplantation e.V., Stolberg, Germany. 3. Department of Internal Medicine, St.-Antonius-Hospital Eschweiler, Eschweiler, Germany. 4. Dialysezentrum Aachen Praxis und Dialyse, Aachen, Germany. 5. Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany. 6. Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany; Bayer Pharma AG, Global Drug Development, Kidney Diseases Research, Wuppertal, Germany. 7. Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany; Department of Internal Medicine, Dresden-Friedreichstadt Hospital, Dresden, Germany. 8. Department of Neurology, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany; Jülich Aachen Research Alliance (JARA)-Translational Brain Medicine, Aachen and Jülich, Germany; Dialysezentrum Aachen Praxis und Dialyse, Aachen, Germany. 9. Jülich Aachen Research Alliance (JARA)-Translational Brain Medicine, Aachen and Jülich, Germany; Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany. 10. Department of Neurology, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany; Jülich Aachen Research Alliance (JARA)-Translational Brain Medicine, Aachen and Jülich, Germany; Institute of Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, Jülich, Germany. Electronic address: kreetz@ukaachen.de.
Abstract
BACKGROUND: Cognitive impairment in hemodialysis (HD) patients is frequent and mediated by several factors. It is unclear which patients are more susceptible to cognitive variations around the dialysis cycle and which clinical factors may play a mediator role. We aimed to answer these issues by investigating intraindividual changes within the dialysis cycle. STUDY DESIGN: Cross-sectional observational study with repeated measures. SETTING & PARTICIPANTS: 47 HD patients and 40 controls without kidney disease, both without history of neurologic disease. PREDICTORS: Dialysis vintage, disease duration, vascular risk factors, comorbidity index score, intradialytic weight change, frequency of hypotensive episodes, and biochemical levels (hemoglobin, leukocytes, urea, creatinine, sodium, and potassium). Covariates included demographics (age, education, and sex). OUTCOMES & MEASUREMENTS: Significant individual deterioration in attention and executive functions (phasic and intrinsic alertness, Stroop test, and Trail Making Test) after dialysis, as measured by a regression-based reliable change method. Regression models were used to identify clinical predictors of individual cognitive decline after dialysis. RESULTS: After dialysis, patients primarily showed prolonged reaction times and psychomotor slowing. However, individual-based analyses revealed that fluctuations in attention and executive functions were present in only a minority of patients. Significant individual fluctuations on particular attention and executive tasks were associated moderately with intradialytic hypotensive episodes, as well as with psychoactive medication, and were predicted weakly by blood leukocyte count, sodium level, dialysis vintage, and volume. LIMITATIONS: Small sample size; patient group younger and healthier than the overall HD population, limiting generalizability. CONCLUSIONS: Only a minority of patients exhibit significant individual cognitive fluctuations, predominantly showing deterioration after dialysis in attention and executive functions. Susceptibility to such fluctuations was predicted in part by both HD-dependent and -independent factors.
BACKGROUND:Cognitive impairment in hemodialysis (HD) patients is frequent and mediated by several factors. It is unclear which patients are more susceptible to cognitive variations around the dialysis cycle and which clinical factors may play a mediator role. We aimed to answer these issues by investigating intraindividual changes within the dialysis cycle. STUDY DESIGN: Cross-sectional observational study with repeated measures. SETTING & PARTICIPANTS: 47 HDpatients and 40 controls without kidney disease, both without history of neurologic disease. PREDICTORS: Dialysis vintage, disease duration, vascular risk factors, comorbidity index score, intradialytic weight change, frequency of hypotensive episodes, and biochemical levels (hemoglobin, leukocytes, urea, creatinine, sodium, and potassium). Covariates included demographics (age, education, and sex). OUTCOMES & MEASUREMENTS: Significant individual deterioration in attention and executive functions (phasic and intrinsic alertness, Stroop test, and Trail Making Test) after dialysis, as measured by a regression-based reliable change method. Regression models were used to identify clinical predictors of individual cognitive decline after dialysis. RESULTS: After dialysis, patients primarily showed prolonged reaction times and psychomotor slowing. However, individual-based analyses revealed that fluctuations in attention and executive functions were present in only a minority of patients. Significant individual fluctuations on particular attention and executive tasks were associated moderately with intradialytic hypotensive episodes, as well as with psychoactive medication, and were predicted weakly by blood leukocyte count, sodium level, dialysis vintage, and volume. LIMITATIONS: Small sample size; patient group younger and healthier than the overall HD population, limiting generalizability. CONCLUSIONS: Only a minority of patients exhibit significant individual cognitive fluctuations, predominantly showing deterioration after dialysis in attention and executive functions. Susceptibility to such fluctuations was predicted in part by both HD-dependent and -independent factors.
Authors: Charles Chazot; Ken Farrington; Ionut Nistor; Wim Van Biesen; Hanneke Joosten; Daniel Teta; Dimitrie Siriopol; Adrian Covic Journal: Int Urol Nephrol Date: 2015-09-16 Impact factor: 2.370
Authors: Dawn F Wolfgram; Lily Sunio; Elisabeth Vogt; Heather M Smith; Alexis Visotcky; Purushottam Laud; Jeff Whittle Journal: Nephrology (Carlton) Date: 2014-12 Impact factor: 2.506
Authors: Frances E Tiffin-Richards; Ana S Costa; Bernhard Holschbach; Rolf D Frank; Athina Vassiliadou; Thilo Krüger; Karl Kuckuck; Theresa Gross; Frank Eitner; Jürgen Floege; Jörg B Schulz; Kathrin Reetz Journal: PLoS One Date: 2014-10-27 Impact factor: 3.240
Authors: Kathrin Reetz; Zaheer Abbas; Ana Sofia Costa; Vincent Gras; Frances Tiffin-Richards; Shahram Mirzazade; Bernhard Holschbach; Rolf Dario Frank; Athina Vassiliadou; Thilo Krüger; Frank Eitner; Theresa Gross; Jörg Bernhard Schulz; Jürgen Floege; Nadim Jon Shah Journal: PLoS One Date: 2015-03-31 Impact factor: 3.240