0213 GMT September 20, 2019
The findings, which appeared in the Journal of the American Society of Nephrology (JASN), may help explain why previous studies have found a link between hemodialysis and worsening cognitive function in elderly patients, according to medicalxpress.com.
More than two million people with kidney failure worldwide currently receive treatment with dialysis or a kidney transplant to stay alive, with the majority of patients undergoing hemodialysis.
Recent studies have provided increasing evidence that although conventional in-center hemodialysis can prolong lives, it may also have negative effects on the brain that lead to cognitive deficits. Investigators have hypothesized that the repetitive circulatory stress of hemodialysis — which filters a patient's blood outside the body before returning it — may reduce the blood supply to the brain; however, the mechanisms involved are unclear.
To investigate, Harmke Polinder-Bos, MD (University Medical Center Groningen, in The Netherlands) and her colleagues studied the effects of conventional hemodialysis on cerebral blood flow (CBF), measured by special positron emission tomography-computed tomography imaging tests.
During single hemodialysis sessions in 12 patients? 65 years of age, three scans were performed: before, early after the start of, and at the end of hemodialysis.
From before the start to the end of hemodialysis, CBF declined significantly by 10percent, from an average of 34.5-30.5 ml-100 g per minute. CBF decline caused clinical symptoms in 1 patient.
Regional CBF declined in all brain regions that were examined, including the frontal, parietal, temporal, and occipital lobes; cerebellum; and thalamus.
Hemodialysis treatment-related factors that might relate to CBF decline were a higher body temperature in patients, a greater ultrafiltration volume and ultrafiltration rate during dialysis, and a higher blood pH.
In an accompanying perspective article, Dawn F. Wolfgram, MD (Medical College of Wisconsin and Clement Zablocki VA Medical Center) noted that for many patients there may be other options available for treating kidney failure.
She said, "Peritoneal dialysis, short frequent home dialysis, and nocturnal dialysis do not cause the significant hemodynamic stress that commonly accompanies conventional hemodialysis.
"The underutilization of these alternative dialytic techniques in the United States may have allowed the complications of hemodialysis to become more apparent, especially as older and sicker patients begin renal replacement therapy with in- center hemodialysis."