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Association of Arterial Stiffness and Central Pressure With Cognitive Function in Incident Hemodialysis Patients: The

Esther D Kim1,2,3, Lucy A Meoni3,4,5, Bernard G Jaar1,3,4,6

  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Kidney International Reports
|December 23, 2017
PubMed

Insights

Vascular stiffness, measured by augmentation index (AIx) and central pulse pressure (cPP), is linked to cognitive decline in new hemodialysis patients. These markers may contribute to impaired cognitive function over time.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Neuroscience

Background:

  • Cognitive impairment is prevalent in hemodialysis patients.
  • Vascular disease is a suspected cause, but detailed vascular assessments in new patients are understudied.

Purpose of the Study:

  • To investigate the association between detailed vascular stiffness measures and cognitive function in incident hemodialysis patients.
  • To assess aortic stiffness (pulse-wave velocity, PWV) and systemic arterial stiffness (augmentation index, AIx, central pulse pressure, cPP) in relation to cognitive processing speed, executive function, and global cognitive impairment.

Main Methods:

  • Prospective study of incident hemodialysis participants (Predictors of Arrhythmic and Cardiovascular Risk in ESRD - PACE study).
  • Vascular stiffness assessed via PWV, AIx, and cPP.
  • Cognitive function evaluated using Trail making tests A and B (TMTA, TMTB) and modified Mini-Mental State Exam (3MS).

Main Results:

  • Higher AIx and cPP were associated with longer TMTB and global cognitive impairment at 1 year, even after multivariable adjustment.
  • PWV was not independently associated with cognitive outcomes at 1 year.
  • Every 10% increase in AIx correlated with a 0.14 log-seconds increase in TMTB and a 10.23-fold increased odds of cognitive impairment.

Conclusions:

  • Elevated AIx and cPP, reflecting abnormal wave reflections, are associated with cognitive decline in patients initiating hemodialysis.
  • These vascular parameters may play a role in the pathogenesis of cognitive impairment in this population.
Abstract

Keywords:
arterial stiffnesscentral blood pressurecognitive functionend-stage renal diseasehemodialysisvascular disease

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