Cognitive Function and Dialysis Adequacy: No Clear Relationship

Giang, Lena M.; Weiner, Daniel E.; Agganis, Brian T.; Scott, Tammy; Sorensen, Eric P.; Tighiouart, Hocine; Sarnak, Mark J.

doi:10.1159/000322611

Cited by 53 publications

(42 citation statements)

References 58 publications

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“…In contrast to older studies, Giang et al [32] have not demonstrated any association between higher achieved dialysis dose and better performance on any cognitive testing in the current era of increased dialysis dose. Therefore, our findings of improved cognitive and psychomotor performance of adequately dialyzed patients after kidney transplantation suggest that kidney transplantation is superior to adequate HD in improving cognitive and psychomotor function in maintenance HD patients.…”

Section: Discussionmentioning

confidence: 79%

Kidney Transplantation Improves Cognitive and Psychomotor Functions in Adult Hemodialysis Patients

Radić

Ljutić²,

Radić³

et al. 2011

Am J Nephrol

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Background: Kidney failure is believed to have a negative impact on cognitive function, and cognitive impairment is common among maintenance hemodialysis (HD) patients. Previous studies have shown a beneficial effect of kidney transplantation in certain cognitive tests but not across all cognitive domains assessed. But, most of these studies performed a cross-sectional analysis, suffered from lack of standardization of adequate dialysis dose, hemoglobin level, and insufficient sensitivity of neuropsychological tests. The aim of this study was to evaluate the effect of successful kidney transplantation on cognitive and psychomotor function in adequately dialyzed HD patients without severe anemia, using sensitive neuropsychological tests. Methods: Twenty-one medically stable patients (aged 45.1 ± 7.9 years) on maintenance HD (7.6 ± 4.2 years) were investigated before and 20.5 ± 8.5 months after successful kidney transplantation using Complex Reactiometer Drenovac, a battery of computer-generated psychological tests which measure a simple visual discrimination of signal location, short-term memory, simple convergent visual orientation and convergent thinking. Results: Our findings indicated significantly better cognitive and psychomotor performance after transplantation on tests that assess processing speed, attention, short time memory, convergent thinking and executive functioning. Also, significant negative correlation between follow-up time after transplantation and cognitive and psychomotor performance in minimum time of solving test of convergent thinking was found. Conclusion: We conclude that cognitive and psychomotor functions are superior after successful kidney transplantation compared with HD, and that early beneficial effects of transplantation are not transient and cognitive and psychomotor performance might be even improved in time following successful transplantation.

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Section: Discussionmentioning

confidence: 79%

Kidney Transplantation Improves Cognitive and Psychomotor Functions in Adult Hemodialysis Patients

Radić

Ljutić²,

Radić³

et al. 2011

Am J Nephrol

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“…Cognitive deficits in dialysis patients also improve after transplantation 21 22. As yet, there is no significant association between blood pressure, intradialytic hypotension, dialysis adequacy or frequency and cognitive impairment 23 24…”

Section: Cognitive Impairment In Advanced Kidney Diseasementioning

confidence: 99%

Determinants of quality of life in advanced kidney disease: time to screen?

Iyasere

Brown

2014

Postgraduate Medical Journal

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The incidence of older patients with end stage renal disease is on the increase. This group of patients have multiple comorbidities and a high symptom burden. Dialysis can be life sustaining for such patients. But it is often at the expense of quality of life, which starts to decline early in the pathway of chronic kidney disease. Quality of life is also important to patients and is a major determinant in decisions regarding renal replacement. As a result, validated patient-reported outcome measures are increasingly used to assess quality of life in renal patients. Cognitive impairment, depression, malnutrition and function decline are non-renal determinants of quality of life and mortality. They are under-recognised in the renal population but are potentially treatable, if not preventable. This review article discusses aetio-pathogenesis, prevalence and impact of these four outcomes, advocating regular screening for early identification and management.

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“…These tests evaluate cognitive function in the domains of attention, visual-spatial, and processing speed (Ferenci et al 2002;Bajaj et al 2009;McQuillan and Jassal 2010). Given that various cognitive dysfunction (memory, attention, language and executive functions) have been reported in patients with ESRD (Giang et al 2010;Radić et al 2010;Bugnicourt et al 2013), we used the battery of neuropsychological tests mentioned above to assess cognitive impairment in ESRD patients. Moreover, these ESRD patients without overt encephalopathy were subdivided into minimal nephrotic encephalopathy (MNE) group and non-nephro-encephalopathy (non-NE) group according to the test results of NCT-A and DST.…”

Section: Laboratory and Neuropsychological Evaluationmentioning

confidence: 99%

Altered long- and short-range functional connectivity in the patients with end-stage renal disease: a resting-state functional MRI study

Zhang

Wen

et al. 2015

Metab Brain Dis

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To investigate alterations of functional connectivity density (FCD) in patients with end-stage renal disease (ESRD) by using resting-state functional magnetic resonance imaging (rs-fMRI). Medical research ethics committee approval from Jinling hospital and written informed consent from each subject were obtained. Forty six patients with ESRD, consisting of 21 patients minimal nephrotic encephalopathy (MNE) and 25 non-nephro-encephalopathy (non-NE), as well as 23 healthy controls underwent rs-fMRI. Neuropsychological tests were performed in all subjects, while laboratory tests were performed in ESRD patients. A voxel-wise whole brain functional connectivity analysis was used to generate long- and short-range FCD maps. The maps among MNE, non-NE, and healthy controls groups were compared by using one-way analysis of variance tests. A multiple regression analysis was performed to evaluate the correlations between FCD and the variables of neuropsychological or laboratory tests. Compared with healthy controls, non-NE showed decreased long-range FCD mainly in parietal lobe. Moreover, MNE showed further decreased long-range FCD in bilateral middle prefrontal cortex (MPFC), anterior cingulate cortex (ACC) and right superior frontal gyrus. Meanwhile, non-NE showed decreased short-range FCD mainly in frontal cortex, and further reduction in bilateral ACC and right superior parietal gyrus in MNE. In addition, patients with ESRD mainly exhibited increased long-range FCD in left temporal lobe and caudate; and increased short-range FCD in bilateral orbitofrontal cortex and temporal gyri (P < 0.05, AlphaSim corrected). The number connection test type A score, serum creatinine, urea, and dialysis duration showed negative correlation with FCD in some brain regions, while the digital symbol test scores positively correlated with short-range FCD in left inferior parietal lobule (all P < 0.05, AlphaSim corrected). The prominent long- and short-range FCD reduction was found mainly in default mode network (DMN) and bilateral frontal and parietal lobes, while the progressively decreased long- and short-range FCD in ACC/MPFC and the long-range FCD in left superior frontal gyrus from non-NE to MNE was associated with cognition dysfunction in ESRD patients.

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Cognitive Function and Dialysis Adequacy: No Clear Relationship

Cited by 53 publications

References 58 publications

Kidney Transplantation Improves Cognitive and Psychomotor Functions in Adult Hemodialysis Patients

Kidney Transplantation Improves Cognitive and Psychomotor Functions in Adult Hemodialysis Patients

Determinants of quality of life in advanced kidney disease: time to screen?

Altered long- and short-range functional connectivity in the patients with end-stage renal disease: a resting-state functional MRI study

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