Executive function in end-stage renal disease: Acute effects of hemodialysis and associations with clinical factors

Objective: To describe the most common clinical factors and stroke etiologies in a case series of patients with end-stage renal disease on hemodialysis (ESRD/HD) with transient ischemic attack (TIA) or ischemic stroke (IS). Background: Prior studies have shown that patients on HD are at an elevated risk of stroke, but these studies have focused on the overall stroke risk. This case series sought to determine the percentage of acute ischemic events that occur during or immediately after HD. Methods: ICD-9 codes were used to identify IS and TIA patients with ESRD/HD admitted to the stroke service from August 22, 2011, to June 21, 2014. Charts were reviewed to determine the age, sex, and race/ethnicity of the cohort. TIA/IS diagnosis was confirmed by a vascular neurologist. Clinical factors were assessed, including: onset during or shortly after HD, defined as occurring within 12 h of HD; the presence of a lesion on diffusion-weighted MRI; hypotension, hyponatremia, or hypoglycemia at symptom onset; the stroke etiology; the presence of focal neurologic deficits; whether the patient was in the window period for intravenous tissue plasminogen activator (IVtPA) upon presentation, and whether the patient received IVtPA. Results: We identified 34 ESRD/HD patients with a diagnosis of TIA/stroke in the specified time period. A majority of patients (70.6%) were African American. Patient age ranged from 32 to 84 years, with a median age of 67 years. Twenty-seven patients (79.4%) had confirmed ischemic infarcts on diffusion-weighted MRI. Seven patients (20.6%) were diagnosed with TIA. In 13 patients (38.2%), symptom onset occurred during or shortly after HD. Of these 13 patients, 8 (61.5%) had symptom onset during HD. Three patients (8.8%) had documented hypotension near the time of symptom onset, and 2 (5.9%) were hyponatremic on presentation to the emergency department. The distribution of stroke etiologies was as follows: 4 (11.8%) watershed distribution, 1 (2.9%) large artery atherosclerosis, 2 (20.6%) small vessel disease, 10 (29.4%) cardioembolic, and 9 (26.5%) cryptogenic. In 28 patients (82.4%), focal neurologic deficits were observed on presentation. Nine patients (26.5%) arrived within the window period for IVtPA, and 4 (11.8%) were eligible and received IVtPA. Conclusions: Of all patients with ESRD on HD admitted to the stroke service over the study period, over one third (38.3%) had the onset of their ischemic event during or shortly after HD, and nearly one quarter (23.5%) had the onset during HD. While clinicians may be tempted to attribute neurologic changes after HD to metabolic etiologies, they should also be aware that HD represents a period of elevated risk for acute ischemia.

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Acute effect of one session of hemodiafiltration with endogenous reinfusion on uremic toxins and inflammatory mediators

The International Journal of Artificial Organs ◽

10.1177/0391398819899102 ◽

2020 ◽

Vol 43 (7) ◽

pp. 437-443

Author(s):

Xiaohong Chen ◽

Bo Shen ◽

Xuesen Cao ◽

Fangfang Xiang ◽

Jianzhou Zou ◽

...

Keyword(s):

Renal Disease ◽

Inflammatory Mediators ◽

End Stage Renal Disease ◽

Uremic Toxins ◽

Nutrient Loss ◽

Infusion Therapy ◽

Acute Effects ◽

Long Term Treatment ◽

Stage Renal Disease ◽

End Stage

Aims: To investigate the acute effects of hemodiafiltration with endogenous infusion on the elimination of uremic toxins and inflammatory mediators in patients with end-stage renal disease. Materials and methods: A total of 37 end-stage renal disease patients undergoing chronic hemodialysis received a single hemodiafiltration with endogenous infusion dialysis treatment. The acute effects of one hemodiafiltration with endogenous infusion session on uremic toxins and inflammatory mediators were assessed by comparing the pre- and post-hemodiafiltration with endogenous infusion concentrations. Results: Hemoglobin and albumin were stable during hemodiafiltration with endogenous infusion therapy. The mean reduction ratios of β2-microglobulin, p-cresyl sulfate, and indoxyl sulfate were 43.60%, 40.91%, and 43.64%, respectively. Tumor necrosis factor-α also decreased significantly at a mean rate of 28.10%, while the concentrations of interleukin-6 and high-sensitivity C-reactive protein remained unchanged after one session of hemodiafiltration with endogenous infusion. Conclusion: The hemodiafiltration with endogenous infusion system is a new dialysis technique that combines diffusion, convection, and adsorption processes. It allows for extensive solute removal, including protein-bound uremic toxins and some pro-inflammatory cytokines, but does not cause nutrient loss and inflammatory response during the treatment. Although the effect after a single hemodiafiltration with endogenous infusion session is limited, it may be improved by repeated and long-term treatment.

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Acute effects of hemodialysis on lung function in patients with end-stage renal disease

Wiener klinische Wochenschrift ◽

10.1007/s00508-006-0564-7 ◽

2006 ◽

Vol 118 (3-4) ◽

pp. 108-113 ◽

Cited By ~ 14

Author(s):

Susanne M. Lang ◽

Anja Becker ◽

Rainald Fischer ◽

Rudolf M. Huber ◽

Helmut Schiffl

Keyword(s):

Lung Function ◽

Renal Disease ◽

End Stage Renal Disease ◽

Acute Effects ◽

Stage Renal Disease ◽

End Stage

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Abstract 560: Association of Female Gender with Arterial Stiffness in Patients With End-Stage Renal Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.560 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Isabella Guajardo ◽

Mills Claire ◽

Peter Ganz ◽

Carmen A Peralta ◽

Ruth Dubin

Keyword(s):

Peritoneal Dialysis ◽

Arterial Stiffness ◽

Renal Disease ◽

End Stage Renal Disease ◽

Female Gender ◽

Dialysis Session ◽

Clinical Factors ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage

Objectives: Cardiovascular mortality remains disproportionately high in patients with end-stage renal disease (ESRD), and arterial stiffness is a strong risk factor for death in these patients. Recent studies have shown that women are at increased risk for death in this population. We explored whether arterial stiffness differed by gender in a diverse cohort of patients on hemo- or peritoneal dialysis. Methods: Stable patients on hemo- or peritoneal dialysis (N=86) underwent arterial stiffness testing by radial tonometry (SphygmoCor, AtCor Medical). Patients were studied on Tuesday or Wednesday mornings (for patients on hemodialysis, the day after the first dialysis session of the week). Central aortic augmentation index (AIx) was calculated at a standardized heart rate of 75 bpm using a generalized transfer function.[[Unable to Display Character:  ]] Results: The mean±SD age was 54±12 years, 30% were women, 36% were African American, and 38% had diabetes. The median(IQR) years on dialysis was 4(1.8, 7), 80% were on hemodialysis, and 20% were on peritoneal dialysis. Overall, mean±SD Aix was 24±11%; mean±SD Aix was 29±9% for women vs. 21±9% for men (p<0.001). Clinical factors associated with both higher Aix (worse arterial stiffness) and female gender (p≤0.2) included older age, diabetes, lower albumin, lower hemoglobin and higher Kt/V. After adjustment for these covariates, female gender remained a significant correlate of worse arterial stiffness (β=8%;95%CI [-14, -1.7];p=0.01). Further adjustment for peripheral systolic blood pressure, height and weight (parameters used to calculate Aix) did not attenuate this effect (β=9%;95%CI [-15, -3.1];p=0.004). Conclusions: In this ESRD cohort, female gender was associated with higher Aix (worse arterial stiffness) after adjustment for clinical factors. Further studies are needed to explore whether residual confounding explains this association or if hormonal and metabolic factors could lead to worsened arterial stiffness in women with ESRD.

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