Department of Neurology, Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany; Jülich Aachen Research Alliance (JARA)-Translational Brain Medicine, Aachen and Jülich, Germany.
KfH Kuratorium für Dialyse und Nierentransplantation e.V., Stolberg, Germany.
Am J Kidney Dis. 2014 Sep;64(3):434-42. doi: 10.1053/j.ajkd.2014.02.012. Epub 2014 Mar 27.
Cognitive impairment in hemodialysis (HD) patients is frequent and mediated by several factors. It is unclear which patients are more susceptible to cognitive variations around the dialysis cycle and which clinical factors may play a mediator role. We aimed to answer these issues by investigating intraindividual changes within the dialysis cycle.
Cross-sectional observational study with repeated measures.
SETTING & PARTICIPANTS: 47 HD patients and 40 controls without kidney disease, both without history of neurologic disease.
Dialysis vintage, disease duration, vascular risk factors, comorbidity index score, intradialytic weight change, frequency of hypotensive episodes, and biochemical levels (hemoglobin, leukocytes, urea, creatinine, sodium, and potassium). Covariates included demographics (age, education, and sex).
OUTCOMES & MEASUREMENTS: Significant individual deterioration in attention and executive functions (phasic and intrinsic alertness, Stroop test, and Trail Making Test) after dialysis, as measured by a regression-based reliable change method. Regression models were used to identify clinical predictors of individual cognitive decline after dialysis.
After dialysis, patients primarily showed prolonged reaction times and psychomotor slowing. However, individual-based analyses revealed that fluctuations in attention and executive functions were present in only a minority of patients. Significant individual fluctuations on particular attention and executive tasks were associated moderately with intradialytic hypotensive episodes, as well as with psychoactive medication, and were predicted weakly by blood leukocyte count, sodium level, dialysis vintage, and volume.
Small sample size; patient group younger and healthier than the overall HD population, limiting generalizability.
Only a minority of patients exhibit significant individual cognitive fluctuations, predominantly showing deterioration after dialysis in attention and executive functions. Susceptibility to such fluctuations was predicted in part by both HD-dependent and -independent factors.
血液透析（HD）患者常伴有认知障碍，且这种障碍是由多种因素介导的。目前尚不清楚哪些患者更容易出现透析周期相关的认知变化，以及哪些临床因素可能发挥中介作用。我们旨在通过研究透析周期内的个体内变化来回答这些问题。
具有重复测量的横断面观察性研究。
47 名 HD 患者和 40 名无肾脏疾病且无神经病史的对照组。
透析龄、疾病持续时间、血管危险因素、合并症指数评分、透析期间体重变化、低血压发作频率以及生化水平（血红蛋白、白细胞、尿素、肌酐、钠和钾）。协变量包括人口统计学数据（年龄、教育和性别）。
通过基于回归的可靠变化方法测量，与透析前相比，注意力和执行功能（阶段性和内在警觉性、Stroop 测试和 Trail Making 测试）在透析后显著恶化。使用回归模型来确定透析后个体认知下降的临床预测因素。
只有少数患者表现出显著的个体认知波动，主要表现为透析后注意力和执行功能下降。对这种波动的易感性部分由 HD 依赖和非依赖因素预测。
