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Intradialytic hypotension and relationship with cognitive function and brain morphometry
Santiago Cedeño1, Manuel Desco2, Yasser Aleman2
1Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
Intradialytic hypotension (IDH), even when asymptomatic, is linked to reduced brain white matter and hippocampus volume and lower cognitive function in dialysis patients. This highlights the brain's vulnerability to haemodynamic stress during dialysis.
Area of Science:
- Nephrology
- Neurology
- Radiology
Background:
- Dialysis-induced haemodynamic stress may impair central nervous system (CNS) integrity.
- Investigating the link between intradialytic hypotension (IDH) and brain changes is crucial.
Purpose of the Study:
- To analyze the relationship between intradialytic hypotension (IDH) and cognitive function.
- To assess the association between IDH and brain morphometry in chronic kidney disease (CKD) patients undergoing hemodialysis (HD).
Main Methods:
- The cross-sectional KIDBRAIN study included 68 CKD patients undergoing HD.
- Analyzed 18 dialysis sessions, recording IDH events.
- Assessed global cognitive function (GCF) using the Mini-Mental State Examination (MMSE) and brain structure via MRI morphometry (grey matter, white matter, hippocampus).
Main Results:
- More IDH sessions correlated with lower white matter (WM) and hippocampus volume.
- Global cognitive function (GCF) was associated with WM volume.
- Symptomatic IDH was significantly linked to reduced GCF.
Conclusions:
- Intradialytic hypotension (IDH) is associated with reduced white matter and hippocampus volume and lower GCF in hemodialysis patients, even if asymptomatic.
- These findings suggest the brain is vulnerable to haemodynamic stress during dialysis sessions.
Background:
The haemodynamic stress brought about by dialysis could justify the loss of structural and functional integrity of the central nervous system (CNS). The main objective of this study was to analyse the relationship between intradialytic hypotension (IDH) and cognitive function and brain morphometry.
Methods:
The cross-sectional KIDBRAIN study (Cohort Study of Morphological Changes of the Brain by MRI in Chronic Kidney Disease Patients) included 68 prevalent patients with no history of neurological disorders (cerebrovascular disease and cognitive impairment) undergoing haemodialysis (HD). We analysed 18 non-consecutive dialysis sessions (first three of each month over a 6-month period) and various definitions of IDH were recorded. Global cognitive function (GCF) was assessed using the Mini-Mental State Examination (MMSE) and parameters of structural integrity of the CNS were obtained using volume morphometry magnetic resonance imaging analysis [grey matter (GM), white matter (WM) and hippocampus).
Results:
A greater number of sessions with IDH were associated with less volume of WM (r = -0.359,P = 0.003) and hippocampus (r = -0.395, P = 0.001) independent of cardiovascular risk factors according to multivariable linear regression models (β = -0.198, P = 0.046 for WM; β = -0.253, P = 0.017 for hippocampus). The GCF by the MMSE was 27.3 ± 7.3.1 and was associated with WM volume (β = 0.403, P = 0.001) independent of GM and hippocampus volume. Symptomatic IDH was associated with GCF (r = -0.420, P < 0.001) in adjusted analysis (β = -0.339, P = 0.008).
Conclusions:
Even when asymptomatic, IDH is associated with a lower WM and hippocampus volume and reduced GCF in patients undergoing HD, thus suggesting greater vulnerability of the brain to the haemodynamic stress that may be generated by a dialysis session.
