title: Haemodynamics during dialysis and cognitive performance.
abstract: OBJECTIVE
  Persons receiving haemodialysis (HD) are at increased risk of cognitive impairment (CI). Since blood pressure (BP) fluctuations during HD may affect cerebral perfusion - and subsequently cognitive function - we examined the relationship between dialytic BP fluctuation and cognitive outcomes.
  
  
  METHODS
  We included HD patients without diagnosed dementia who were 50 years or older. Using established methods, we classified participants' in CI categories (none to mild and moderate to severe) based on results of a neurocognitive battery. We collected demographic and laboratory data from dialysis unit records, as well as all BP measurements from 12 dialysis sessions. We tested the association between CI and BP fluctuation, adjusting for demographic and laboratory variables.
  
  
  RESULTS
  Our study enrolled 39 patients; 25 had moderate to severe CI. The normal to mild CI group and the moderate to severe patients had similar degrees of BP fluctuation (average minimum systolic BP (SBP): 107.6 ± 18.7 vs 110.2 ± 18.6 mmHg, maximum drop in SBP: 32.6 ± 10.2 vs 35.4 ± 15.0 mmHg; proportion of sessions with SBP < 90 mmHg: 0.2 ± 0.3 vs 0.2 ± 0.3; average change in SBP, pre to post HD: 10.2 ± 12.4 vs 11.8 ± 16.4 mmHg, all P > 0.55). There was no association between BP variables and performance on individual cognitive tests. Multivariable analysis showed that older age and non-Caucasian race were associated with a reduction in cognitive scores.
  
  
  CONCLUSIONS
  There was no cross-sectional association between dialytic BP changes and cognitive performance.
authors.affiliation: Section of Nephrology, Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA; Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Dawn F
authors.initials: DF
authors.lastname: Wolfgram
authors.forename: Lily
authors.initials: L
authors.lastname: Sunio
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vogt
authors.forename: Heather M
authors.initials: HM
authors.lastname: Smith
authors.forename: Alexis
authors.initials: A
authors.lastname: Visotcky
authors.forename: Purushottam
authors.initials: P
authors.lastname: Laud
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002560:Cerebrovascular Circulation; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D014922:Wisconsin / Q000453:epidemiology
keywords: blood pressures; cognitive impairment; haemodialysis; hypotension
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