Does a Patent Foramen Ovale Influence Cognitive Function in Dialysis Patients?

Abstract

Background: Patients with chronic kidney disease on dialysis treatment have poorer cognitive function than age- and sex-matched controls. One proposed mechanism is cerebral microembolisation due to material from the dialysis circuit crossing a patent foramen ovale (PFO). Methods: Cognitive testing was carried out in haemodialysis (HD) patients and peritoneal dialysis (PD) patients. Transthoracic echocardiography was used to identify PFO. Follow-up testing 1 year later enabled comparison of cognitive decline between patients with and without a PFO, and between those undergoing different dialysis modalities. Results: 80 patients (aged 60.4 ± 15.0 years) were recruited (51 HD patients and 29 PD controls). A PFO was found in 21% of patients. 83% of dialysis patients suffered a decline in one or more cognitive function tests over 1 year. There was a significant difference in only one test between HD patients with or without a PFO. PD patients showed a more rapid cognitive decline than those on HD. Conclusions: Cognitive decline in dialysis patients is rapid and affects most patients. The presence of a PFO made only subtle differences to the rates of cognitive decline during 1 year of follow-up. Patients with a PFO should not be prevented from considering HD because of concerns of cerebral decline due to microembolisation.

Cognitive Dysfunction and Health-Related Quality of Life in Patients with End-Stage Renal Disease Undergoing Hemodialysis in Comparison with Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

“…During hemodialysis, massive and uncontrollable hemodynamic and metabolic changes in the brain can contribute to cognitive decline, and the fluid overloading and secondary metabolic disorders from glucose-based dialysate used in peritoneal dialysis can contribute to cognitive dysfunction [ 19 ]. Previous studies have suggested that hemodialysis was associated with better cognitive function than peritoneal dialysis, which was in line with our findings [ 20 , 21 ]. George et al also demonstrated that patients with hemodialysis had better performance, especially in attention, memory, visuospatial, and orientation [ 21 ].…”

“…Previous studies have suggested that hemodialysis was associated with better cognitive function than peritoneal dialysis, which was in line with our findings [ 20 , 21 ]. George et al also demonstrated that patients with hemodialysis had better performance, especially in attention, memory, visuospatial, and orientation [ 21 ]. However, results of studies on the effects of peritoneal dialysis and hemodialysis on cognitive dysfunction are inconsistent.…”

The comparison of cognitive function and risk of dementia in CKD patients under peritoneal dialysis and hemodialysis

“…Among them, 2 studies adopted MMSE measuring the CF. [16,26] Digit symbol test (DST), FAS verbal fluency (FASVF), digit span backwards (DSB) and trails (BA) (TBA) were used in the study of George et al [27] TMT, SDMT, RAVLT, BVRT and Grooved Pegboard (GP) were used in the study of Griva et al [28] Meanwhile, MoCA was used in another 2 studies. [29,30] The TMT-B, Test d2-Revision (d2-R) and Kidney Disease Quality of Life Cognitive Function (KDQOL-CF) methods were used in the studies of Newmann et al and Robinski et al [31,32] The measurement of SDMT was conducted in the study of Radić, [21] while the study of Sithinamsuwan et al adopted the Thai Mental Status Examination (TMSE).…”

“…George et al showed that patients with PD showed a more rapid cognitive decline than those on HD. [27] Also, Lambert et al showed that patients with HD had better performance in visuospatial, attention, memory and orientation, compared with PD. [30]…”

Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action

“…The lack of validated tools to detect cognitive or physical deterioration means that the PD team is relied upon to spot problems before they present as a crisis. Although tools to detect cognitive decline and score comorbidity do exist, healthcare workers often simply report the decline and eventual crisis that causes a patient to discontinue PD and lack effective interventions, patient permission or resources to modify the outcomes. One possible solution that allows patients to remain on PD is to offer assisted PD either as respite or as an indefinite answer for those without prospects of being able to return to a previously functioning state .…”