Dixon Bradley S, VanBuren John M, Rodrigue James R, Lockridge Robert S, Lindsay Robert, Chan Christopher, Rocco Michael V, Oleson Jacob J, Beglinger Leigh, Duff Kevin, Paulsen Jane S, Stokes John B
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Veterans Administration Medical Center, Iowa City, IA, USA.
BMC Nephrol. 2016 Jan 22;17:12. doi: 10.1186/s12882-016-0223-9.
It is uncertain whether switching to frequent nocturnal hemodialysis improves cognitive function in well-dialyzed patients and how this compares to patients who receive a kidney transplant.
We conducted a multicenter observational study with longitudinal follow-up of the effect on cognitive performance of switching dialysis treatment modality from conventional thrice-weekly hemodialysis to frequent nocturnal hemodialysis, a functioning renal transplant or remaining on thrice-weekly conventional hemodialysis. Neuropsychological tests of memory, attention, psychomotor processing speed, executive function and fluency as well as measures of solute clearance were performed at baseline and again after switching modality. The change in cognitive performance measured by neuropsychological tests assessing multiple cognitive domains at baseline, 4 and 12 months after switching dialysis modality were analyzed using a linear mixed model.
Seventy-seven patients were enrolled; 21 of these 77 patients were recruited from the randomized Frequent Hemodialysis Network (FHN) Nocturnal Trial. Of these, 18 patients started frequent nocturnal hemodialysis, 28 patients received a kidney transplant and 31 patients remained on conventional thrice-weekly hemodialysis. Forty-eight patients (62 %) returned for the 12-month follow-up. Despite a significant improvement in solute clearance, 12 months treatment with frequent nocturnal hemodialysis was not associated with substantial improvement in cognitive performance. By contrast, renal transplantation, which led to near normalization of solute clearance was associated with clinically relevant and significant improvements in verbal learning and memory with a trend towards improvements in psychomotor processing speed. Cognitive performance in patients on conventional hemodialysis remained stable with the exception of an improvement in psychomotor processing speed and a decline in verbal fluency.
In patients on conventional thrice-weekly hemodialysis, receiving a functioning renal transplant was associated with improvement in auditory-verbal memory and psychomotor processing speed, which was not observed after 12 months of frequent nocturnal hemodialysis.
对于透析充分的患者，改为夜间频繁血液透析是否能改善认知功能，以及与接受肾移植的患者相比情况如何，目前尚不确定。
我们进行了一项多中心观察性研究，对将透析治疗方式从传统的每周三次血液透析改为夜间频繁血液透析、进行功能性肾移植或继续每周三次传统血液透析对认知表现的影响进行纵向随访。在基线时以及改变透析方式后再次进行记忆、注意力、心理运动处理速度、执行功能和流畅性的神经心理学测试以及溶质清除率的测量。使用线性混合模型分析在基线、改变透析方式后4个月和12个月时通过评估多个认知领域的神经心理学测试所测量的认知表现变化。
共纳入77例患者；这77例患者中有21例来自随机的频繁血液透析网络（FHN）夜间试验。其中，18例患者开始夜间频繁血液透析，28例患者接受肾移植，31例患者继续每周三次传统血液透析。48例患者（62%）返回进行12个月的随访。尽管溶质清除率有显著改善，但夜间频繁血液透析治疗12个月与认知表现的实质性改善无关。相比之下，肾移植使溶质清除率接近正常，与言语学习和记忆的临床相关且显著改善以及心理运动处理速度有改善趋势相关。除心理运动处理速度有所改善和言语流畅性下降外，接受传统血液透析的患者认知表现保持稳定。
在接受每周三次传统血液透析的患者中，接受功能性肾移植与听觉言语记忆和心理运动处理速度的改善相关，而夜间频繁血液透析12个月后未观察到这种情况。
