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Abstract: TH-PO318

Orthostatic Blood Pressure Decline as a Possible Explanation for Memory Deficit in Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Liu, Wenjin, Nanjing Medical University, Nanjing, JIangSu, China
  • Wang, Lulu, Nanjing Medical University, Nanjing, JIangSu, China
  • Yang, Junwei, Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
Background

Memory deficit is usually ignored by nephrologists but can be detrimental to patients’ quality of life as well as prognosis. A better understanding of the mechanisms underlying this condition could improve the care of CKD patients. Here we sought to test the hypothesis that orthostatic blood pressure decline contributes to memory deficit in patients with end-stage renal disease.

Methods

Sixty patients on maintenance hemodialysis and 60 healthy controls (without CKD, cardiovascular diseases or neurologic diseases) were included. Patients and controls were frequency-matched by age, sex and education. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition while the Auditory Verbal Learning Test (AVLT) was used for episodic memory evaluation. Seated and standing blood pressure were measured. Frequency domain heart rate variability (HRV) were recorded and analyzed.

Results

Compared with controls, patients had significantly lower scores of MoCA and AVLT (learning memory, short delayed recall, long delayed recall). They also exhibited rapid blood pressure decline upon standing, with a delayed compensatory rebound following. Correlation analyses showed that orthostatic blood pressure decline was not associated with cognition or memory in the controls, whereas it was correlated significantly to both short recall and delayed recall scores in the patients. Multiple stepwise regression analysis revealed that orthostatic blood pressure decline is an independent predictor for memory deficit (both short recall and delayed recall). The association between orthostatic blood pressure decline and short recall remained significant after adjusting for HRV.

Conclusion

Our study reveals significant memory deficit and overt orthostatic blood pressure decline upon standing in patients receiving maintenance hemodialysis. Orthostatic blood pressure decline is associated independently with memory test scores in a reverse fashion in hemodialysis patients and this association remained significant even after adjusting for heart rate variability, suggesting that orthostatic blood pressure decline possibly induce memory deficit directly, rather than merely a reflection of general cerebral injury.

Funding

  • Government Support - Non-U.S.