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 at 1 year.
Why the study?
Do arterial stiffness and central pressure associate with cognitive decline in incident hemodialysis patients?
Cohort (n=333)
Yes
Do arterial stiffness and central pressure associate with cognitive decline in incident hemodialysis patients?
Higher systemic arterial stiffness and central pulse pressure are associated with declining executive function and global cognitive impairment in incident hemodialysis patients.
Answers are grounded in this paper and cite their sources.
Should not yet change practice in hemodialysis; hypothesis-generating for arterial stiffness as a modifiable cognitive risk factor.
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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Kim et al. (2017) conducted a cohort in Incident hemodialysis (n=333). Arterial stiffness (AIx) and central pulse pressure (cPP) was evaluated on 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). Every 10% increase in augmentation index and 10 mm Hg increase in central pulse pressure were associated with higher odds of global cognitive impairment at 1 year.
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