Blood Pressure and Cognitive Decline in Prevalent Hemodialysis Patients

Abstract

Background: Hypertension is associated with cognitive decline in the general population. It is unclear what impact blood pressure (BP) has on cognitive decline in patients receiving maintenance hemodialysis (HD). Methods: Using a longitudinal cohort of 314 prevalent HD patients without dementia at baseline, we examined the association of predialysis systolic BP (SBP) and diastolic BP (DBP), pulse pressure, and intradialytic SBP change (pre minus post), averaged for a month, with cognitive decline. Cognitive function was determined by a neurocognitive battery, administered yearly. Individual cognitive test results were reduced into 2 domain scores using principal components analysis (by definition mean of 0 and SD of 1), representing memory and executive function. Joint models, allowing for characterization of cognitive score slopes and including adjustment for potential confounders, were utilized to account for competing risks from death, dropout, or kidney transplantation. Results: Mean age was 62 years; 54% were men, 23% were black, and 90% had at least a high school education. During median follow-up of 2.1 years (25th–75th: 1.0–4.5), 191 had at least one follow-up test, 148 died, and 43 received kidney transplants. Low predialysis DBP and high pulse pressure were both associated with steeper executive function decline (each 10 mm Hg lower DBP = –0.03 SD [–0.01 to –0.05] per year steeper decline) in executive function (each 10 mm Hg higher pulse pressure = –0.03 SD [–0.06 to –0.01] steeper decline) but not for memory function. SBP and intradialytic change were not associated with steeper decline for either memory or executive function. Conclusions: No relationship was seen between SBP or intradialytic change in BP with cognitive decline. In prevalent HD patients, lower predialysis DBP and wider predialysis pulse pressure are associated with steeper cognitive decline in executive function but not memory.

Cognitive Function and Vitamin D Status in the Chinese Hemodialysis Patients

“…A study by Jovanovich et al [29] of 605 veterans with advanced CKD and chronic dialysis reported that the Except for the correlation between serum 25(OH)D and MoCA-B scores, previous studies have confirmed the associations between higher SBP and DBP and cognitive impairment in the general population [30]. However, other studies suggested that there was no relationship between changes in SBP or intradialytic change in blood pressure with cognitive function decline [31]. Our study also found there is no relationship between SBP and cognitive function.…”

Cognitive Impairment Early After Initiating Maintenance Hemodialysis: A Cross Sectional Study

“…This suggests that there might be factors intrinsic to HD that are more relevant to the development of CI. Intradialytic hypotension is a likely mechanism associated with CI in HD patients ( 13 , 44 ). indeed, cumulative exposure to intradialytic hypotension has been linked to new-onset dementia in HD patients ( 45 ).…”

Intensive blood pressure control on dementia in patients with chronic kidney disease: Potential reduction in disease burden

“…A meta-analysis study including twenty studies has concluded that both higher systolic or diastolic BP and higher systolic or diastolic BP variability are individually associated with cognitive impairment and dementia while the effect of BP variability is higher compared to mean BP values in a statistically significant manner (OR, 0.92 [95% CI, 0.87-0.97], P<0.01) [41]. Furthermore, there are contradictory studies regarding the effects of BP variability during hemodialysis on cognitive function while it is crucial to emphasize that studies conducted in this field on hemodialysis patients include a low number of participants and has higher rates of loss of follow-up due to either mortality and kidney transplantation [42,43].…”