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Abstract: TH-PO653

Intradialytic Cerebral Perfusion and Cognitive Outcomes in Older Adults on Hemodialysis

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Wolfgram, Dawn F., Medical College of Wisconsin, Wauwatosa, Wisconsin, United States
  • Richerson, Wesley, Medical College of Wisconsin/Marquette University, Milwaukee, Wisconsin, United States
Background

End-stage renal disease affects over 600,000 Americans; with the majority of patients treated with hemodialysis (HD). Over two thirds of HD patients have significant cognitive impairment. Although causes of cognitive impairment may be multifactorial, there is some evidence that HD-process may lead to cognitive decline through cerebral ischemic disease from HD related hemodynamic fluctuations. We hypothesize that, at baseline white matter integrity will be associated with change in intradialytic cerebral perfusion and cognitive performance.

Methods

Participants are over the age of 50 who have been on HD fewer than 2 years. Our predictor variable is change in intradialytic cerebral oximetry (ScO2). We include three cognitive outcome measures; patient-reported cognition survey, neuropsychological assessment, and white matter integrity on MRI.

Results

Currently 25 participants are enrolled, with 20 completing all baseline measurements (5 unable to do MRI). The mean (SD) age was 65.4 (6.6) years. Majority were males (72%) and Caucasian (64%). Most had diabetes (64%) and hypertension (80%). Overall cerebral oximetry declined during HD session with a mean drop of 7.0 (2.9) %. Participants reported overall no cognitive issues with mean PROMIS cognition score of 55.3 (9.8) against normative score of 50 for the general population. This contrasts with the neuropsychological scores showing deficits in test of executive function (39.8 (7.6)) and processing speed (40.0 (9.1)), again against normative score of 50. Correlational analysis demonstrates that greater intradialytic drop in ScO2 was associated with lower FA scores in some white matter tracts.

Conclusion

In our interim analysis we see that HD patients have cognitive deficits in key domains of executive function and processing speed and worse white matter integrity compared to healthy controls. Our results also show that cerebral oximetry does fluctuate during routine HD sessions. Our preliminary analysis demonstrate a trend of greater intradialytic cerebral oximtery decline being associated with lower white matter integrity in certain tracts, but the currently small sample size shows variability in results. Enrollment is ongoing and future analysis will include more participants.

Funding

  • NIDDK Support