scholarly journals Cognitive performance in dialysis patients - "when is the right time to test?"

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hristos Karakizlis ◽  
Stefanie Thiele ◽  
Brandon Greene ◽  
Joachim Hoyer

Abstract Background Cognitive impairment in chronic kidney disease, especially in end stage renal disease, is a public health problem. Nevertheless, the cause of chronic kidney disease still remains unclear. A prevalence of cognitive impairment in patients with end stage renal disease of up to 87% has been found. Methods The study at hand deals with the research on the – potential – effect of timing on cognitive performance when testing cognitive impairment in hemodialysis patients during the dialysis cycle. We tested cognitive performance with a neuropsychological test battery (RBANS, Repeatable Battery for the Assessment of Neuropsychological Status) on two occasions while patients were on dialysis as well as on a dialysis-free day. In addition, all participants were rated using the Geriatric Depression Scale (GDS) and several demographic and clinical variables were recorded in order to investigate their possible influence on cognitive performance. The patients were recruited in three dialysis centers in the central region of Hesse, Germany. Twenty-six participants completed the 3 testings during a period of 6 weeks. The testing was carried out in the dialysis centers. Results Looking at the total scale score, patients achieved the best cognitive performance in the RBANS during the first 2 h on dialysis with 81.1 points. When comparing the scores of the three measurement occasions (first 2 h, Timepoint 1 vs. last 2 h, Timepoint 2 vs. dialysis free day, Timepoint 3, however, no significant difference in the total scale score was detected. But patients showed significantly better cognitive performance in language in the first 2 h (p < 0.001) as well as in the last 2 h (p < 0.001) compared with the dialysis-free day. Conclusion Due to the high prevalence of cognitive impairment, there is an increasing need to assess cognitive function in dialysis patients. Our data show that the time point of testing (first 2 h on hemodialysis vs. last 2 h on hemodialysis vs. Hemodialysis free day) had no influence of cognitive function in hemodialysis patients in routine indications.

Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.


RSC Advances ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 1915-1922 ◽  
Author(s):  
Qiong Wu ◽  
Xue-li Lai ◽  
Hong-xia Zhao ◽  
Zhen-yu Zhu ◽  
Zhan-ying Hong ◽  
...  

Anemia is an almost universal complication of chronic kidney disease (CKD), and nearly all patients with end-stage renal disease (ESRD) and approximately 70% of those with earlier stages of CKD receive treatment for anemia.


2017 ◽  
Vol 10 ◽  
pp. 117863291771302 ◽  
Author(s):  
Rabih Nasr ◽  
Sridhar Chilimuri

Optimal preoperative management of dialysis patients remains challenging. Patients with end-stage renal disease (ESRD) have higher mortality in the perioperative setting compared with non-ESRD patients. However, it is well established that dialysis should be done on the day before surgery. Additional dialysis session prior to surgery does not improve outcomes. All dialysis patients should undergo blood work to check electrolytes and especially serum potassium prior to any surgery. Some medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics, should be stopped prior to surgery to minimize hemodynamic changes during surgery. The dialysis access should be carefully examined for any signs of infection. The arteriovenous fistula or graft should be evaluated for patency. Glycemic control in diabetic ESRD and chronic kidney disease patients is very important, and clinicians should be aware of the risk of bleeding and the appropriate analgesics that can be used in dialysis patients in the perioperative setting. In conclusion, preoperative evaluation in patients with ESRD should be a multidisciplinary approach.


2016 ◽  
Vol 2 (1) ◽  
pp. 42 ◽  
Author(s):  
Muhammad Hanif ◽  
Hina Javed ◽  
Umair Jallani ◽  
Nazar Muhammad Ranjha

Chronic kidney disease(CKD) is the cause of irreversible detoriation of renal function which leads to end stage renal disease(ESRD).incidence of end stage renal disease has increased dramatically during last 30 years and screening for early stages of chronic kidney disease is often suggested as preventive measure.the main cause of end stage renal disease are diabetes, high blood pressure,hyperlipidemia and obesity.obesity and increased BMI are the cause of kidney stone and chronic kidney disease.this reports aim to determine the prevalance of end stage renal disease in diabetic obese individuals and other problems that are more likely to be encountered in the end stage renal disease are cardiovascular risks in dialysis patients.GFR and creatinine clearance are used as the major diagnostic tool to determined the kidney function. calcium level is also used as predictive factor to determine the vascular calcification.


2017 ◽  
pp. 28-33
Author(s):  
Thi Khanh Trang Ngo ◽  
Bui Bao Hoang

Background: Although procalcitonin (PCT) has been described as a new marker of inflammation in dialysis patients, it has not been studied in patients with end-stage renal disease (ERSD) in Viet Nam. The objective of this study was to evaluate: serum PCT levels in patients with ERSD and its association to other inflammation (hs-CRP, IL-6) and nutritional (albumin, prealbumin, BMI) factors and the cardiovascular disease (CVD) events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) after 1-year follow-up. Subjects and methods: A total of 174 patients without infection (include: 57 predialysis patients, 56 continuous ambulatory peritoneal dialysis patients, 61 hemodialysis patients) were enrolled. Inflammatory markers (PCT, hs-CRP, IL-6) and nutritional parameters (albumin, prealbumin, BMI) were determined. CVD events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) were evaluated during 12 months of follow-up. Results: The median baseline serum PCT levels of them were 0.44 ng/ml (0.23 – 0.98). Of them, 79 patients (45.4%) had baseline serum PCT levels of over 0.5 ng/ml, which is the cut-off point suggestive of sepsis in non-dialytic individuals. Hemodialysis patients was associated with significantly higher PCT values than predialysis and peritoneal dialysis patients. The patients with elevated PCT plasma levels had the BMI lower. PCT and IL-6 were positively correlated with each other. Compared to patients with serum PCT levels of under 0.5 ng/ml, patients with serum PCT levels of over 0.5 ng/ml had an increased CVD risk in 12 months of follow-up (HR: 2.09; 95% CI: 1.31-3.33; p=0.002). Conclusion: In the absence of infection, PCT may increase due to reduced renal elimination and increased synthesis. Furthermore, serum PCT could serve as a marker of low-grade inflammation, which substantially increase CVD events risk in patients with ERSD. Keywords: Procalcitonin, end-stage renal disease


2017 ◽  
Vol 4 (07) ◽  
pp. 1432
Author(s):  
Mahdi Mohammadian ◽  
Hamid Salehiniya ◽  
Salman Khazaei ◽  
Abdollah Mohammadian-Hafshejani

Chronic kidney disease (CKD) is known as a major health problem worldwide (Levey et al., 2007). The CKD is defined as a stage of disease in which the patient's kidney function is less than a half of normal capacity (2). If the kidney function is 10% to 15% less than the normal capacity, the patient has reached the End Stage Renal Disease (ESRD). At this stage, the kidney transplant or dialysis with hemodialysis or peritoneal dialysis is necessary for patient's survival (Levey et al., 2002).


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