Cognitive impairment in patients on hemodialysis

A.V. Smirnov, I.A. Vasilieva, R.V. Golubev

Scientific Research Institute of Nephrology of the First St. Petersburg State Medical University n.a. Acad. I.P. Pavlov
Purpose. To clarify the nature and severity of cognitive impairment (CL) in patients receiving hemodialysis (HD), data on the frequency of the occurrence of CI and to analyze whether the use of succinate-containing bicarbonate dialysis fluid (SCBDF) improves the cognitive functions (CF) in patients?
Material and methods. The study included 99 patients who were treated with HD. Benton visual retention test, CF scale of the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire, and the "Repetition of digits", "WAIS test" and "Reading counts" methods were used for the assessment.
Results. Score below 7 on the "Repetition of digits" test indicating the presence of CI was observed in 10% of patients. There were no patients who were unable to replicate the preorder number of four digits (which may indicate the presence of dementia). Only 13% of patients had more than three errors in the "Reading Counts" test. Only 4% of patients had less than 6 correctly reproduced cards in the Benton test. Comparison of this indicator with the estimates for general intelligence according to the WAIS test and Stanford-Binet test has shown that mean value of 7.3 ± 1.5 in the present study occupies an intermediate position between the middle level of intelligence and lower limit of normal. Thus, the results of study indicate the presence of moderate CI with mild decrease in attention, memory, and reaction rate in 10 to 20% of patients on HD. Data scattering is associated with application of multiple cognitive tests in the study. As a result of treatment with the use of SCBDF, the number of errors in reproducing of cards with geometrical figures is reduced (before treatment – 2.1 ± 1.4, 6 months after treatment – 1.7 ± 1.4, P = 0.04), and number of patients with points below 60 according to the СА scale of the KDQOL-SF questionnaire is decreased (before treatment - 14%, 6 months after treatment - 5%, P = 0.04).
Conclusion. 10 to 20% of patients on HD have moderate CI. The positive dynamics of CF indicators during the treatment with the SCBDF is observed.

About the Autors

Information about the authors:
Smirnov A.V. - Professor, Director of the SRI of Nephrology, Head of the Department of Propaedeutics of Internal Diseases of the First St. Petersburg State Medical University named after Academician I.P. Pavlov (FSPbSMU), MD
Vasilyeva I.A. - Senior Researcher at the Laboratory of the kidney failure SRI of Nephrology FSPbSMU, Doctor of Psychological Sciences
Golubev R.V. – Head of the Laboratory of the kidney failure SRI of Nephrology FSPbSMU, MD

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