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

Bradley S Dixon; John M VanBuren; James R Rodrigue; Robert S Lockridge; Robert Lindsay; Christopher Chan; Michael V Rocco; Jacob J Oleson; Leigh Beglinger; Kevin Duff; Jane S Paulsen; John B Stokes; Frequent Hemodialysis Network (FHN) Study

doi:10.1186/s12882-016-0223-9

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

Journal article

Open access

Peer reviewed

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

Bradley S Dixon, John M VanBuren, James R Rodrigue, Robert S Lockridge, Robert Lindsay, Christopher Chan, Michael V Rocco, Jacob J Oleson, Leigh Beglinger, Kevin Duff, …

BMC nephrology, Vol.17(1), 12

01/22/2016

DOI: 10.1186/s12882-016-0223-9

PMCID: PMC4722762

PMID: 26801094

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Abstract

It 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. We 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. Seventy-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. In 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.

Follow-Up Studies

Verbal Learning

Dialysis Solutions

Humans

Memory

Middle Aged

Renal Dialysis - methods

Male

Reaction Time

Cognition

Renal Insufficiency, Chronic - therapy

Time Factors

Adult

Female

Executive Function

Psychomotor Performance

Renal Dialysis - psychology

Renal Insufficiency, Chronic - psychology

Attention

Hemoglobins - metabolism

Neuropsychological Tests

Renal Insufficiency, Chronic - blood

Phosphorus - blood

Kidney Transplantation - psychology

Creatinine - blood

Longitudinal Studies

Details

Title: Subtitle: Cognitive changes associated with switching to frequent nocturnal hemodialysis or renal transplantation
Creators: Bradley S Dixon - University of Iowa, Internal Medicine
John M VanBuren - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA. john-vanburen@uiowa.edu
James R Rodrigue - Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center and the Harvard Medical School, Boston, MA, USA. jrrodrig@bidmc.harvard.edu
Robert S Lockridge - Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA, USA. boblockridge@gmail.com
Robert Lindsay - Department of Medicine, The University of Western Ontario, London, ON, Canada. robert.lindsay@lhsc.on.ca
Christopher Chan - Department of Medicine, University of Toronto, University Health Network, Toronto, ON, Canada. christopher.Chan@uhn.ca
Michael V Rocco - Department of Medicine, Wake Forest School of Medicine , Winston-Salem, NC, USA. mrocco@wakehealth.edu
Jacob J Oleson - University of Iowa, Biostatistics
Leigh Beglinger - Departments of Psychiatry, Neurology and Psychology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. leigh-beglinger@uiowa.edu
Kevin Duff - Departments of Psychology and Neurology, University of Utah, Salt Lake City, UT, USA. kevin.duff@hsc.utah.edu
Jane S Paulsen - University of Iowa, Psychological and Brain Sciences
John B Stokes
Frequent Hemodialysis Network (FHN) Study
Resource Type: Journal article
Publication Details: BMC nephrology, Vol.17(1), 12
DOI: 10.1186/s12882-016-0223-9
PMID: 26801094
PMCID: PMC4722762
NLM abbreviation: BMC Nephrol
ISSN: 1471-2369
eISSN: 1471-2369
Publisher: BioMed Central; England
Grant note: R01 DK074715 / NIDDK NIH HHS R01-DK074715 / NIDDK NIH HHS
Language: English
Date published: 01/22/2016
Academic Unit: Biostatistics
Record Identifier: 9984001798802771

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