Cognitive changes associated with switching to frequent nocturnal hemodialysis or renal transplantation

BMC Nephrology

Research Article

James R. Rodrigue¹  John M. VanBuren²  Jacob J. Oleson²  John B. Stokes³  Bradley S. Dixon⁴  Robert S. Lockridge⁵  Robert Lindsay⁶  Christopher Chan⁷  Michael V. Rocco⁸  Leigh Beglinger⁹  Jane S. Paulsen⁹  Kevin Duff^1,10 

[1] Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center and the Harvard Medical School, Boston, MA, USA;Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA;Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA;Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA;Veterans Administration Medical Center, Iowa City, IA, USA;Nephrology Division, University of Iowa School of Medicine, E300D GH, 200 Hawkins Drive, 52242-1081, Iowa City, IA, USA;Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA, USA;Department of Medicine, The University of Western Ontario, London, ON, Canada;Department of Medicine, University of Toronto, University Health Network, Toronto, ON, Canada;Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA;Departments of Psychiatry, Neurology and Psychology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA;Departments of Psychology and Neurology, University of Utah, Salt Lake City, UT, USA;

关键词: Renal replacement therapy;    Frequent nocturnal hemodialysis;    Renal transplantation;    Cognitive impairment;    Cognition;    Neuropsychological testing;   

DOI  :  10.1186/s12882-016-0223-9

 received in 2015-08-29, accepted in 2016-01-08,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundIt 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.MethodsWe 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.ResultsSeventy-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.ConclusionsIn 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.

【 授权许可】

CC BY   
© Dixon et al. 2016