透析对终末期肾病患者认知功能的时间效应。

Temporal effects of dialysis on cognitive functioning in patients with ESRD.

作者信息

Williams Mark A, Sklar Allan H, Burright Richard G, Donovick Peter J

机构信息

Environmental Neuropsychology Laboratory, State University of New York at Binghamton, Binghamton, NY, USA.

出版信息

Am J Kidney Dis. 2004 Apr;43(4):705-11. doi: 10.1053/j.ajkd.2003.12.031.

DOI:10.1053/j.ajkd.2003.12.031

PMID:15042548

Abstract

BACKGROUND

Although dialysis has been shown to improve cognitive deficits resulting from uremia, little is known about potential temporal variations in cognitive measures between hemodialysis treatments.

METHODS

We studied dialysis patients for possible fluctuations in attention and memory by using repeatable neuropsychological measures. Twenty patients undergoing hemodialysis on a thrice-weekly dialysis schedule were assessed at intervals of 1, 24, and 67 hours after the last weekly hemodialysis session. For purposes of comparison, we also studied 10 patients on continuous ambulatory peritoneal dialysis (CAPD) therapy at similar intervals.

RESULTS

CAPD patients showed overall stable performance on measures of attention and memory. However, hemodialysis patients showed significant changes (P < 0.05) in auditory memory for both immediate and delayed recall, with the greatest impairment occurring 67 hours postdialysis. Hemodialysis patients also showed a significant change (P < 0.05) in attention between the second and third test periods, ie, 24 to 67 hours postdialysis, with the greatest impairment seen at the 67-hour assessment time. No relationship was found between performance on measures of cognition and levels of postdialysis fatigue in hemodialysis patients.

CONCLUSION

CAPD patients showed cognitive stability, whereas hemodialysis patients showed temporal fluctuations in cognitive performance.

摘要

背景

尽管透析已被证明可改善尿毒症导致的认知缺陷，但对于血液透析治疗之间认知指标潜在的时间变化知之甚少。

方法

我们通过使用可重复的神经心理学测量方法研究透析患者的注意力和记忆力是否存在波动。对20例按每周三次透析方案进行血液透析的患者，在最后一次每周血液透析治疗后的1、24和67小时进行评估。为作比较，我们还对10例接受持续性非卧床腹膜透析（CAPD）治疗的患者在相似的时间间隔进行了研究。

结果

CAPD患者在注意力和记忆力测量方面总体表现稳定。然而，血液透析患者在即时回忆和延迟回忆的听觉记忆方面均出现显著变化（P<0.05），最大损伤出现在透析后67小时。血液透析患者在第二个和第三个测试期之间，即透析后24至67小时，注意力也出现显著变化（P<0.05），在67小时评估时损伤最大。在血液透析患者中，认知测量表现与透析后疲劳程度之间未发现相关性。