Cardiovascular Disease and Cognitive Function in Maintenance Hemodialysis Patients

Abstract

Background Cardiovascular disease (CVD) and cognitive impairment are common in dialysis patients. Given the proposed role of microvascular disease on cognitive function, particularly cognitive domains that incorporate executive functions, we hypothesized that prevalent systemic CVD would be associated with worse cognitive performance in hemodialysis patients. Design Cross-sectional cohort Setting and Participants 200 maintenance hemodialysis patients without prior stroke from 5 Boston-area hemodialysis units Predictor CVD, defined by history of coronary disease or peripheral vascular disease Outcome Performance on a detailed neurocognitive battery. Primary analyses quantified cognitive performance using principal components analysis to reduce cognitive tests to a processing speed/executive function domain and a memory domain. Multivariable linear regression models adjusted for age, sex, education, race and other clinical and demographic characteristics. Results Mean (SD) age of participants was 62 (18) years and 75 (38%) had CVD. Individuals with CVD were older, more likely to be men, diabetic, and current or former smokers. In adjusted models, individuals with CVD performed 0.50 standard deviations worse (p<0.001) on tests assessing processing speed/executive function, while there was no difference in performance on tests of memory. Similar results were seen when assessing individual tests, with performance on the block design, digit symbol coding and Trail Making Tests A and B significantly associated with CVD in age, sex, education and race-adjusted analyses and approaching toward significance in fully adjusted models. Limitations CVD ascertainment dependent on patient recall and dialysis unit documentation. No brain imaging. Conclusions The presence of CVD is associated with worse cognitive performance on tests of processing speed and executive functioning in hemodialysis patients and identifies a high risk population for greater difficulty with complex tasks.

Low 25-Hydroxyvitamin D Levels and Cognitive Impairment in Hemodialysis Patients

“…In the general population, cerebrovascular disease and Alzheimer's disease are the most common causes of cognitive impairment, with these conditions not infrequently occurring in conjunction. However, in hemodialysis patients, cerebrovascular disease is likely to play a more important role given the high prevalence of cardiovascular disease at all stages of CKD (3,4). Several traditional vascular risk factors, including older age, hypertension, and dyslipidemia, as well as concurrent coronary or peripheral vascular disease, are associated with worse cognitive performance in dialysis patients (1,3,5).…”

“…However, in hemodialysis patients, cerebrovascular disease is likely to play a more important role given the high prevalence of cardiovascular disease at all stages of CKD (3,4). Several traditional vascular risk factors, including older age, hypertension, and dyslipidemia, as well as concurrent coronary or peripheral vascular disease, are associated with worse cognitive performance in dialysis patients (1,3,5). However, few studies have examined the relationship between nontraditional cardiovascular disease risk factors and cognitive function in this population.…”

Frequency of and risk factors for poor cognitive performance in hemodialysis patients

“…We had previously demonstrated that vascular disease, as assessed by either coronary disease or peripheral vascular disease, is associated with abnormalities in executive function in hemodialysis patients. 24 The current study adds to the latter by including a larger number of individuals, evaluating many potential risk factors for cognitive impairment, providing detailed comparisons with normative data, and incorporating additional cognitive tests that were assessed in nearly half of the study participants. Our study has several strengths.…”

Predictors of Cognitive Dysfunction among Patients with Moderate to Severe Chronic Kidney Disease

“…Reports have also highlighted the high incidence of cerebral ischemia in the etiopathogenesis of cognitive impairment in CKD, and this is thought to be due to the shared microvascular risk factors between CKD and brain ischemia [16]. Systematic cardiovascular risk factors directly predict poorer executive function [17]. It has been observed that in early stages of chronic renal disease, high levels of albuminuria, a surrogate for systemic vascular disease, is associated with worsening executive function and abnormal magnetic resonance imaging (MRI) findings [18][19][20].…”