Abstract: FR-PO883

Differential Effects of Hemodialysis and Transplantation on Cognitive Function in ESRD

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Findlay, Mark Duncan, University of Glasgow, Glasgow, United Kingdom
  • Mark, Patrick B., University of Glasgow, Glasgow, United Kingdom
  • Dawson, Jesse, University of Glasgow, Glasgow, United Kingdom
Background

Cognitive impairment (CI) is common in people receiving hemodialysis (HD). We examined for changes in cognitive function during the HD session and the effect of continued HD or renal transplantation on cognitive function at 12 months

Methods

Prospective observational study in adult patients on chronic HD. A neurocognitive battery was performed during a routine dialysis session and on a non-dialysis day. Cognitive tests included the Montreal Cognitive Assessment and additional tests of language, memory, processing speed and executive function. Mean flow velocity (MFV) was measured in the middle cerebral artery before, during and after dialysis using transcranial Doppler ultrasound. We compared cognitive function and MFV on and off dialysis and assessed the relationship between any changes using Spearman’s rank correlation. Cognitive function was reassessed in a similar fashion 12 months later.

Results

97 participants were enrolled (median age 59yr [IQR 51, 67], 40% female, median duration of end stage renal disease 1.76 years [IQR 0.6, 4.0]). 88 participants attended both intradialytic and non-dialysis day assessments. CI was present in 44(50%). Those with CI were more likely to have hypertension (95.5 v 81.8%, p<0.05). MFV declined during dialysis (mean; 49.8 to 43.2cm/s, p<0.001) correlating with UF volume, r=0.49 p<0.001. Participants scored lower on tests of processing speed and executive function during dialysis when compared to their non-dialysis day scores, p<0.001. Decline in test scores for language and executive function correlated with the dialysis-related fall in MFV, r=-0.27 p=0.02 and r=0.44 p<0.001 respectively. At 12 months, 59 remained on dialysis; 15 transplanted, 5 withdrew and 5 died. Improvements in language and attention tests were observed in those continuing HD, whereas those who received a transplant demonstrated improvements in executive function and processing speed, p<0.05.

Conclusion

Occult CI is common and cognitive function demonstrably worse during dialysis. Cerebral blood flow is reduced during HD, relating to UF volume and a measurable decline in cognitive function. The transient decline in executive function during dialysis does not appear to exert a progressive effect at 12 months, however its significant improvement following transplant highlights an aspect of cognitive function vulnerable to continued HD.

Funding

  • Government Support - Non-U.S.