The Allocation of Vertical Attention in Patients with End-Stage Renal Disease Receiving Dialysis.

Aleksandra Mańkowska,Bogdan Biedunkiewicz,Alicja Dębska-Ślizień,Kenneth M Heilman,John B Williamson,Michał Harciarek

doi:10.3390/brainsci11121549

Abstract

Objectives: Alterations of spatial attention can have adverse effects, such a greater probability of accidents. Patients with end-stage renal disease (ESRD) receiving dialysis have stronger left-sided spatial attentional bias, suggesting that this disorder or treatment alters the brain networks that mediate spatial attention. The hemispheric networks that mediate the allocation of horizontal attention may also influence the allocation of vertical attention. However, the allocation of vertical spatial attention has not been studied in ESRD patients. Methods: Twenty-three ESRD patients receiving dialysis and 23 healthy right-handed controls performed line bisections using 24 vertical lines (24 cm long and 2 mm thick) aligned with the intersection of their midsagittal and coronal planes. Results: Hemodialyzed ESRD patients had a significantly greater upward bias than healthy controls. The magnitude of this bias was correlated with the duration of the kidney disease. Conclusions: The reason why upward attentional bias is increased in hemodialyzed ESRD patients is not known. Further research is needed to better understand the brain mechanism that might account for this bias, as well as its treatment. However, hemodialyzed ESRD patients and their families-caregivers should be made aware of this disorder to avoid accidents such as tripping.

Highlights

Chronic kidney disease (CKD) is a polysymptomatic illness that results from the progressive degeneration of kidney parenchyma
The exact mechanism accounting for cognitive changes is not entirely known, end-stage renal disease (ESRD) patients requiring hemodialysis constitute a population that is at high risk of brain infarcts and brain atrophy
We hypothesized that HD patients’ dorsal attentional stream might be more susceptible to decline due to hypertension and uremic toxicity. This impairment would result in a greater imbalance in the allocation of spatial attention between the ventral and dorsal attentional streams, and this imbalance would increase in the upward vertical attentional bias

Summary

Introduction

Chronic kidney disease (CKD) is a polysymptomatic illness that results from the progressive degeneration of kidney parenchyma. In the beginning of the CKD, the treatment is usually focused on slowing the progression of the illness. The exact mechanism accounting for cognitive changes is not entirely known, ESRD patients requiring hemodialysis (hemodialysis—HD) constitute a population that is at high risk of brain infarcts and brain atrophy. This brain atrophy may result from the chronic exposure to toxins associated with the renal failure and/or comorbid conditions that impair cerebral function (e.g., hypertension, diabetes mellitus) [1,4,5,6,7]

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