What is the clinical evidence from this study?

Study design: Cohort. Population: Incident hemodialysis (n=333). Intervention: Arterial stiffness (AIx) and central pulse pressure (cPP). Primary outcome: Global cognitive impairment (3MS score <80) at 1 year (per 10% increase in AIx) (OR 10.23, 95% CI 1.77-59.00, p=0.01).

August 3, 2017Open Access

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

Q: What are the key findings of this study?

Every 10% increase in augmentation index and 10 mm Hg increase in central pulse pressure were associated with higher odds of global cognitive impairment (OR 10.23 and 2.88, respectively) at 1 year.

Key Result

Every 10% increase in augmentation index and 10 mm Hg increase in central pulse pressure were associated with higher odds of global cognitive impairment (OR 10.23 and 2.88, respectively) at 1 year.

Study Design

Type

Cohort (n=333)

Multicenter

Yes

Structured PICO

Do arterial stiffness and central pressure associate with cognitive decline in incident hemodialysis patients?

Population

333 incident hemodialysis patients (within 6 months of dialysis initiation), mean age 55, 58% male, 72% African American, from 27 outpatient dialysis units in the greater Baltimore area, US.

Intervention

Assessment of aortic stiffness by pulse-wave velocity (PWV), systemic arterial stiffness by augmentation index (AIx), and central pulse pressure (cPP)

Outcome

Cognitive processing speed, executive function, and global cognitive impairment measured by the Trail making test A (TMTA), Trail making test B (TMTB), and the modified Mini-Mental State Exam (3MS) at baseline and 1-year follow-up

Higher systemic arterial stiffness and central pulse pressure are associated with declining executive function and global cognitive impairment in incident hemodialysis patients.

Main Result

Effect estimate: OR 10.23 (95% CI 1.77-59.00)

p-value: p=0.01

Limitations

Participant recruitment from a single region
Limited assessment of cognitive function and cerebrovascular disease without an extended battery of tests and brain imaging
Loss to follow-up due to hospitalizations, transition to transplantation or peritoneal dialysis, and significant early mortality

Abstract

INTRODUCTION: Cognitive impairment commonly occurs in hemodialysis patients, with vascular disease potentially implicated in its pathogenesis. However, the relationship of detailed vascular assessment with cognitive function in patients new to hemodialysis has not been demonstrated. METHODS: In a prospective study of incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD (PACE) study, we determined aortic stiffness by pulse-wave velocity (PWV), systemic arterial stiffness by the augmentation index (AIx) and central pulse pressure (cPP), and examined their associations with cognitive processing speed, executive function, and global cognitive impairment measured by the Trail making test A (TMTA), Trail making test B (TMTB), and the modified Mini-Mental State Exam (3MS). RESULTS: : 2.88; 95% CI: 1.48-5.59). DISCUSSION: Higher AIx and cPP, which are indicative of abnormal wave reflections in distal vessels, are associated with, and might contribute to, declining cognitive function in patients starting hemodialysis.

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