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Abstract: FR-PO430

Risk Factors for Impaired Cerebral Autoregulation and Its Relationship to Cognitive Decline and Brain Atrophy in Hemodialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Goodman, Max J., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Wolfgram, Dawn F., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Background

The hemodialysis (HD) population has evidence of increased cerebral atrophy and cognitive impairment. Understanding if cerebral vascular function and cerebral perfusion during HD may help us understand the pathophysiology of brain atrophy and cognitive impairment. We evaluate cerebral autoregulation (CA) during HD patients in relationship to cerebral structure and cognitive performance.

Methods

In a cross-sectional study, HD patients age 50 years and older receiving incenter HD were included. Cerebral perfusion during HD was measured using cerebral oximetry and an index of CA was calculated based on the correlation between concurrent cerebral oxygen saturation and intradialytic blood pressure. Potential risk factors for worse CA were measured through linear mixed models including patient-level random effects with a compound symmetry covariance structure to account for the correlation in repeated measures from each patient. Additionally, associations between CA and changes in neurocognitive scores as well as white and gray brain matter volumes over 12 months were measured. P-value < 0.05 was considered significant.

Results

We included 46 participants and 121 HD sessions in our analysis. The mean ± SD decline in cerebral oxygen saturation during HD was 7.02% ± 3.16%. An impaired CA index (> 0.4) was noted in 45% of HD sessions. Only diabetes mellitus as a comorbidity survived the linear mixed model method for predicting impaired CA when adjusting for demographics, albumin, dialysis treatment, and oxygen saturation with an OR 1.35 (p < 0.01). The Baseline CA index was negatively correlated with worse picture vocabulary scores at 12 months (r = -0.44, p = 0.03). There was no association between CA index and brain integrity including white and gray matter volume, gray matter thickness, and abnormal voxels at either baseline or 12 months.

Conclusion

Diabetes is associated with worse CA during HD. A worse (higher) CA index correlated to declining cognitive function in HD patients. Further research is needed to understand these relationships in order to reduce cerebral atrophy and cognitive impairment in HD patients.

Funding

  • NIDDK Support