Abstract
BackgroundEnd-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn’t an uncontested result whether cognition was improved or worsened during dialysis.MethodsTo explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group.ResultsNeuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group.ConclusionsOur study revealed that dialysis had a limited effect on cognitive improvement.
Highlights
End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population
After the Generalized linear models (GLMs) analysis, we discovered a significant correlation between Cystatin C and immediate recall total score (IR-S), short-term delayed recall score (SR-S) and longterm delayed recall score (LR-S) in the predialysis group (Table 3)
This study demonstrated that dialysis treatment has a limited protection effect on both cognitive performance and brain networks in ESRD patients, which can be summarized as follows: (i) The IR-S and SR-S comply with the order: healthy controls (HCs) > HD group>predialysis group; the LR-S and recognition score (REC-S) comply with the order: HCs > HD group = predialysis group; (ii) For the global topologic organization of the structural network, both the HD group and predialysis group have reduced the information transfer efficiency compared to HCs; and (iii) Cystatin C level was found to be correlated with the average fiber length of rich club connections in the predialysis group
Summary
End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. It is necessary to explore the effect of dialysis on the pathophysiology of cognitive dysfunction in patients with ESRD. Reproducible results of evidence observed cognitive decline in patients with chronic kidney disease and individuals during their dialysis therapy [5, 24,25,26]. Sabrina et al discovered a reversible part of low neuropsychological testing in patients with ESRD who are receiving a single dialysis session, in the abilities of memory, execution, and psychomotor speed [27]. The effect of dialysis therapy in ESRD patients on cognitive dysfunction remains largely unclear
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