scholarly journals Impact of Cognitive Function Change on Mortality in Renal Transplant and End-Stage Renal Disease Patients

2016 ◽  
Vol 44 (6) ◽  
pp. 462-472 ◽  
Author(s):  
Akhil Sharma ◽  
Jonathan Yabes ◽  
Saleem Al Mawed ◽  
Christine Wu ◽  
Carol Stilley ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Psychomotor Speed ◽  
Executive Performance ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Limited evidence from small-scale studies, mainly involving end-stage renal disease (ESRD) patients, suggests that kidney transplantation may improve cognitive function. We examined changes in cognitive function after a kidney transplant and its association with survival in advanced chronic kidney disease (CKD)/ESRD patients. Methods: In a prospective study design, cognitive performance of 90 patients (50.6 ± 13.1 years, 66.7% men, 27.8% blacks, 76% CKD stages 4-5) was assessed at the respective patients' residences using established neurocognitive tests. Results: Among the 90 patients, 44 received a kidney transplant (KTx group) while 46 did not (no-KTx group). After a mean follow-up of ∼19 months, there was no significant change in scores for majority of cognitive tests in either group. Older age, but not diabetes or renal function status (CKD vs. ESRD), was a determinant of poor follow-up cognitive performance. Additionally, poor attention/psychomotor speed and executive performance (as measured by Trails A and Stroop test, respectively) was associated with higher mortality over a mean follow-up of 4.7 years, even after adjustment for age, sex, diabetes, CKD or ESRD status and kidney transplant status. Conclusion: Overall, cognitive function does not significantly improve after kidney transplant or significantly decline in non-transplanted, advanced CKD/ESRD patients. Poor attention, psychomotor speed and executive performance independent of transplant status were associated with higher mortality over time.

scholarly journals Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

2020 ◽  
Author(s):  
Shaohui Ma ◽  
Ming Zhang ◽  
Yang Liu ◽  
Dun Ding ◽  
Peng Li ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Renal Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Neuropsychological Tests ◽  
Maintenance Hemodialysis ◽  
Rich Club ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients are at substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there did not provide an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), ESRD patients before dialysis initiation (bESRD) and those undergoing maintenance hemodialysis (mESRD). All ESRD patients performed a serious of blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K + and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in mESRD and bESRD groups. Results Neuropsychological analysis showed mESRD exhibited greater cognitive function than bESRD, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the bESRD and mESRD than the HCs. Besides, lower normalized clustering coefficient was in bESRD relative to the HCs and mESRD. For the GLMs analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in bESRD. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement. Cystatin C may be a risk feature of cognitive decline of bESRD.

scholarly journals Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

2020 ◽  
Author(s):  
Shaohui Ma ◽  
Ming Zhang ◽  
Yang Liu ◽  
Dun Ding ◽  
Peng Li ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Renal Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Neuropsychological Tests ◽  
Maintenance Hemodialysis ◽  
Rich Club ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background: End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn’t an uncontested result whether cognition was improved or worsened during dialysis.Methods: To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group.Results: Neuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group.Conclusions: Our study revealed that dialysis had a limited effect on cognitive improvement.

MO641IMPACT OF MAGNESIUM AND L-CARNITINE ADMINISTRATION ON 3-YEAR SURVIVAL IN DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Oleksandr Susla ◽  
Zoriana Litovkina ◽  
Olha Bushtynska
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Carnitine Supplementation ◽  
Basic Therapy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims According to population registries, the survival of diabetic patients with end-stage-renal disease (ESRD) remains low today. In this context, it is reasonable to develop new therapeutic strategies based on advances in science of the important role of magnesium (Mg) and L-carnitine deficiency (via inflammation and endothelial dysfunction) in mechanisms of cardiovascular remodeling, high morbidity and mortality rates. Thus, the purpose of the present study was to evaluate the effect of Mg and L-carnitine supplementation on 3-year survival and development of the cardiovascular complications in diabetic hemodialysis (HD) patients. Method 48 type 2 diabetic ESRD patients were included in this prospective cohort study (male/female, 29/19; age, 59.9±0.6 years; HD duration, 34.8±4.8 month; diabetes mellitus duration, 174.7±7.1 month). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the treatment programme, patients were divided into two groups: the 1st (main) group (n=24) in addition to basic treatment (hypoglycemic, antihypertensive therapy, according to indications - correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the 2nd (comparison) group (n=24) was only on the basic therapy. Complex treatment lasted 12-months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate – by three 2-months’ courses/year. The follow up period in both groups was 36 months. Quantitative data are expressed as means±SEM, qualitative ones – as %. Kaplan-Meier method and Log-rank test were used to estimate survival of HD patients, χ2-test – to compare the frequency values. Results The cumulative proportion of survivors at the end of follow-up was 60.4%; however, after 36 months, the survival rate of diabetic HD patients who received a combination of magnesium aspartate and L-carnitine as part of their modified treatment was significantly higher (75 vs. 45.8%; Log-rank=2.07, p=0.038) compared to patients who were on basic therapy (Figure). Survival time in main and comparison groups was 31.9±1.7 and 26.4±2.2 months respectively. It is noteworthy, that throughout the year (from 10 to 22 months), no completed events were recorded in subjects who underwent Mg and L-carnitine supplementation. Conclusion (1) The combined use of magnesium aspartate and L-carnitine in addition to the basic 12-month treatment provides an effective reduction of cardiovascular complications and promotes 3-year survival of diabetic HD patients. (2) The results obtained substantiate the advisability of using repeated courses of Mg and L-carnitine administration 1 years after the end of the primary modified treatment to improve the prognosis in these ESRD patients.

scholarly journals Impact of kidney transplant on hypertension in diabetic end-stage renal disease (ESRD) patients

2016 ◽  
Vol 10 (4) ◽  
pp. 85
Author(s):  
Bharat Shah ◽  
Nitin Deote Shrikant Adate ◽  
Hepal Vora Zaheer Virani ◽  
Prashant Rajput
Keyword(s):  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Hemodialysis Decreases the Etiologically-Related Early Vascular Aging Observed in End-Stage Renal Disease: A 5-Year Follow-Up Study

2016 ◽  
Vol 43 (1-3) ◽  
pp. 18-30 ◽  
Author(s):  
Daniel Bia ◽  
Cintia Galli ◽  
Yanina Zócalo ◽  
Rodolfo Valtuille ◽  
Sandra Wray ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pulse Wave ◽  
Vascular Aging ◽  
Control Subjects ◽  
Potential Association ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Aims: To analyze the early vascular aging (EVA) in end-stage renal disease (ESRD) patients, attempting to determine a potential association between EVA and the etiology of ESRD, and to investigate the association of hemodialysis and EVA in ESRD patients during a 5-year follow-up period. Methods: Carotid-femoral pulse wave velocity (cfPWV) was obtained in 151 chronically hemodialyzed patients (CHP) and 283 control subjects, and in 25 CHP, who were followed-up after a 5-year lapse. Results: cfPWV increased in ESRD patients compared to control subjects. The cfPWV-age relationship was found to have a steeper increase in ESRD patients. The highest cfPWV and EVA values were observed in patients with diabetic nephropathy. Regression analysis demonstrated a significant reduction of the EVA in HD patients on a 5-year follow-up. Conclusion: Patients in ESRD showed higher levels of EVA. cfPWV and EVA differed in ESRD patients depending on their renal failure etiology. CHP showed an EVA reduction after a 5-year follow-up period.

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals Frail phenotype might herald bone health worsening among end-stage renal disease patients

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3542 ◽  
Author(s):  
Chia-Ter Chao ◽  
Jenq-Wen Huang ◽  
Ding-Cheng Chan ◽  
Keyword(s):  
Lumbar Spine ◽  
Renal Disease ◽  
Bone Health ◽  
End Stage Renal Disease ◽  
Mineral Density ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background Frailty exhibits a high prevalence in end-stage renal disease (ESRD) patients and is associated with adverse health-related outcomes, including falls and fractures. Available studies do not address whether frailty is associated with temporal changes in BMD. We evaluated this issue by analyzing the follow-up dual energy X-ray absorptiometry (DXA) results in an ESRD cohort. Methods In 2015, we enrolled forty-three ESRD patients, divided into frail, pre-frail, and robust ones based on a validated simple FRAIL scale, all receiving DXA at baseline. After one year of follow-up, survivors received another DXA, and we calculated the absolute and percentage changes in area, bone mineral density (BMD), T-, and Z-scores of lumbar spine and femoral neck (FN) between baseline and follow-up examinations. Results Among all, frail individuals with ESRD had significantly lower average lumbar spine area, lower L4, FN, and total BMD and T-scores, lower FN and total Z-scores than non-frail ones, without differences in gender, body mass index, dialysis duration, and comorbidities. Furthermore, we discovered frail ESRD patients had significantly more prominent decrease in average lumbar spine area, percentage changes in L1 Z-scores and average lumbar spine area, and a trend toward more prominent decrease in L4 area than non-frail ones after one year of follow-up. Conclusions Baseline frailty might be associated with deteriorating bone health, including shrinking L-spine areas and a more rapid decrease in L-spine Z scores, among ESRD patients. This frailty-bone association should be highlighted during our care of frail individuals with ESRD.

scholarly journals Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease

2007 ◽  
Vol 113 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Rajan Sharma ◽  
David C. Gaze ◽  
Denis Pellerin ◽  
Rajnikant L. Mehta ◽  
Helen Gregson ◽  
...  
Keyword(s):  
Renal Disease ◽  
Myocardial Ischaemia ◽  
End Stage Renal Disease ◽  
Area Under The Curve ◽  
Dobutamine Stress ◽  
Transplant Candidates ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and 1 h after cessation of DSE. A total of 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5±19.1 compared with 8.2±9.6 kU/l respectively; P=0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/l, with a sensitivity of 81% and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44–0.94); P=0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25±0.71 years. An increase in IMA ≥20 kU/l was associated with significantly worse survival (P=0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA ≥20 kU/l during DSE had significantly worse survival.

scholarly journals Technology-assisted cognitive-behavioral therapy intervention for end-stage renal disease

2019 ◽  
Vol 10 (3) ◽  
pp. 657-663
Author(s):  
Karen P Jakubowski ◽  
Manisha Jhamb ◽  
Jonathan Yabes ◽  
Swathi Gujral ◽  
Lauren E Oberlin ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Behavioral Therapy ◽  
Preliminary Results ◽  
Patient Reported ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Technology-assisted cognitive-behavioral therapy (CBT) interventions have been conducted for symptoms including depression, pain, and fatigue in patients with chronic illnesses but not in end-stage renal disease (ESRD). The purpose of this study was to pilot the feasibility and acceptability of a technology-assisted CBT intervention in ESRD patients on hemodialysis (HD), share design and implementation lessons learned, and provide preliminary results on changes in select patient-reported symptoms. This was a single-center pilot feasibility study of adult ESRD patients on HD. Study eligibility required clinically elevated levels of at least one symptom (depression, pain, or fatigue). Patients met weekly with a CBT therapist for eight sessions, each 45–60 min, during HD sessions via a video-conferencing platform. Symptom questionnaires were completed at baseline and 3 months follow-up. Of 10 patients screened, 100% screened positive for at least one symptom, 100% of eligible patients consented, and eight (of 10) completed the intervention (mean age 59 years, 50% male, 50% African American). Patient adherence and satisfaction was high, and seven of the eight patients completed all eight prescribed sessions. Minimal interference with HD was reported. Preliminary results indicate no statistically significant changes in depression, fatigue, or pain at follow-up. However, there was small improvement in SF-36 Physical Component score [t(7) = −2.60, p = .035], and four of the six patients (67%) with clinically elevated pain at baseline reported improvement at follow-up. A technology-assisted CBT intervention for ESRD patients was feasible, well-accepted, and required minimal additional resources in the HD setting. Larger, adequately powered clinical trials are needed to evaluate the effect on ESRD patient-reported outcomes.

scholarly journals Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaohui Ma ◽  
Ming Zhang ◽  
Yang Liu ◽  
Dun Ding ◽  
Peng Li ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Renal Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Neuropsychological Tests ◽  
Maintenance Hemodialysis ◽  
Rich Club ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn’t an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group. Results Neuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement.

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