engleski

INTRADIALYTIC HYPOTENSION AND COGNITIVE FUNCTION IN MAINTENANCE HAEMODIALYSIS PATIENTS - ARE THEY RELATED?

Background and Aims Intradialytic hypotension (IDH) is common in maintenance haemodialysis patients, which is associated with disabling symptoms and interrupted treatment. Blood pressure fluctuations during haemodialysis may affect cerebral perfusion and subsequently brain atrophy and cognitive impairment. This study aimed to explore the correlation of IDH with brain atrophy and cognitive impairment. Method IDH was defined when the patients showed obvious hypotension symptoms during the dialysis procedure, such as dizziness, sweating or loss of consciousness, accompanied by blood pressure decrement, and needed to be treated by clinicians in the past one year. All patients received 3.0T MRI examination and cognitive function evaluation. We used the voxel-based morphometry (VBM) method to evaluate the changes of brain multi-component volume. All of the brain region (including gray and whiter matter, brain nuclei, ect.) volumes were measured by calculating the total number of voxels in each image data, with resampling voxel size of 1 mm. A wide range of cognitive tests was administered to evaluate cognitive function, including MMSE, MoCA, Philadelphia word learning test, Boston Naming Test, and trial making test. The cognitive function and brain multi-component volume of were compared between patients with and without IDH (IDH and no-IDH groups), and the correlation between brain volume and IDH was investigated by regression analysis. Results Totally 119 maintenance haemodialysis patients enrolled our study. 22 dialysis patients had the experience of IDH, and the prevalence is 18.5%. The patients with IDH had higher prevalence of diabetes and longer dialysis vintage (40.9% vs 16.5, p=0.011 ; 70.0 vs 41.0 months, p=0.054), they also had a lower post-dialysis SBP and DBP. The MMSE scores and MoCA scores of patients with IDH and without IDH were similar (29.0 vs 29.0, p= 0.621 ; 23.5 vs 24.0, p= 0.273). There was no difference in gray matter and white matter between IDH and no-IDH groups. But as for some important brain nuclei and parts associate with emotion and vision, like amygdala, cuneus and posterior cingulate, patient with IDH were smaller than patients without IDH (1.6±0.2 vs 1.7±0.2 mm3, p=0.009 ; 6.9±0.8 vs 7.4±1.0 mm3, p=0.031 ; 6.9±0.8 vs 7.4±0.9 mm3, p=0.024). The multiple-regression analysis showed that IDH was significantly associated with the volume atrophy of amygdala, cuneus and posterior cingulate (β=-0.12, p=0.009 ; β=-0.48, p=0.031 ; β=-0.48, p=0.026). Conclusion IDH was not rare in maintained dialysis patients. IDH may cause some specific brain components atrophy which may relative to emotion and visual changes in dialysis patients but was not associated with cognitive impairment and cognitive relative brain components.

hypotension, cognitive function,

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