Effect of intradialytic cerebral blood flow changes on cognitive decline in middle-aged and elderly maintenance hemodialysis patients
10.3760/cma.j.cn441217-20240920-00936
- VernacularTitle:透析过程中脑血流量变化对中老年维持性血液透析患者认知功能减退的影响
- Author:
Yidan GUO
1
;
Jingying SUN
;
Zhihua SHI
;
Meng JIA
;
Xiaoling ZHOU
;
Chunxia ZHANG
;
Wei CUI
;
Pengpeng YE
;
Yang LUO
Author Information
1. 首都医科大学附属北京世纪坛医院肾内科，北京 100038
- Publication Type:Journal Article
- Keywords:
Renal dialysis;
Ultrasonography, Doppler, transcranial;
Cerebrovascular circulation;
Cognition;
Neuropsychological tests
- From:
Chinese Journal of Nephrology
2025;41(3):177-182
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of intradialytic cerebral blood flow (CBF) fluctuation on cognitive decline in middle-aged and elderly maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. MHD patients aged ≥50 years from Beijing Shijitan Hospital were enrolled from January 2023 to June 2023. Middle cerebral artery mean flow velocity (MFV) was serially monitored via transcranial Doppler (TCD) during dialysis sessions. Cognitive function was assessed at baseline and after 12-month follow-up using standardized neuropsychological tests: montreal cognitive assessment (MoCA), auditory verbal learning test (AVLT 5), complex figure test (CFT), trail making test-B (TMT-B), Stroop color and word test (SCWT), and symbol digit modalities test (SDMT). ΔMFV was calculated as pre-to-post dialysis MFV difference. Multivariable linear regression was used to analyze the association of ΔMFV and cognition.Results:A total of 121 MHD patients were recruited with an age of (63.63±8.44) years. There were 97 males (80.2%), and the dialysis vintage was (55.08±54.73) months. Significant intradialytic MFV reductions were observed ( P<0.05). At 12 months, cognitive decline manifested in global cognition (MoCA), memory (CFT-memory), executive function (TMT-B, SCWT-C, SCWT-T), attention (SDMT), visuospatial ability (CFT-copy)(all P<0.05). Multivariable linear regression analysis revealed ΔMFV independently predicted declines in: MoCA ( B=0.066, 95% CI 0.018-0.113, P=0.007), AVLT5 ( B=0.050, 95% CI 0.004-0.097, P=0.035), TMT-B ( B=-1.955, 95% CI -3.453--0.457, P=0.011), SCWT-C ( B=0.298, 95% CI 0.112-0.484, P=0.002), SCWT-T ( B=-1.371, 95% CI -2.303--0.439, P=0.004). Conclusions:Hemodialysis induces acute CBF reductions detectable by TCD. Cumulative intradialytic CBF fluctuations may accelerate cognitive deterioration in middle-aged and elderly MHD populations, particularly affecting memory and executive domains.
