Background/Aims Persons receiving hemodialysis (HD) are at increased risk of cognitive

Background/Aims Persons receiving hemodialysis (HD) are at increased risk of cognitive impairment (CI). of BP fluctuation (average minimum SBP: 107.6 ± 18.7 vs 110.2 Rabbit polyclonal to APPL1. Pemetrexed disodium ± 18.6 mmHg maximum drop in SBP: 32.6 ± 10.2 vs 35.4 ± 15.0 mmHg; proportion of sessions with SBP < 90 mmHg: 0.2 ± 0.3 vs 0.2 ± 0.3; average change in SBP pre to post HD: 10.2 ± 12.4 vs 11.8 ± 16.4 mmHg all p > 0.55). There was no association between BP variables and performance on individual cognitive tests. Multivariable analysis showed that older age and non-Caucasian race were associated with a reduction in cognitive scores. Conclusions There was no cross-sectional association between dialytic BP changes and cognitive performance. the reason for the lack of Pemetrexed disodium association may be due to the use of prevalent patients in our study rather than incident patients. The effects of hemodynamic fluctuations may be more damaging in the early period of dialysis initiation and level out for persons who have been on dialysis for a number of years. In a recent study on incidence of stroke in persons initiating HD the incidence of stroke peaked in the month after initiation and then subsequently decreased at one year after initiation.30 Likewise small vessel ischemic changes may also occur more frequently Pemetrexed disodium during the months surrounding initiation of dialysis and then stabilize later on. The mean dialysis vintage for our population was over four years. It is possible that during previous years even persons who currently demonstrate hemodynamic stability on dialysis had periods of instability. Given changes in the medical record we do not have information on dialytic BPs from previous years for our participants. Lastly this was a cross-sectional study. A more sensitive measure of the effect of BP on cognitive function may be to evaluate changes in cognitive function longitudinally. The next step is Pemetrexed disodium to repeat cognitive assessment in our cohort one year after baseline assessment to evaluate the rate of decline. Blood pressure measurements over the course of the same one year period will be compared to changes in test scores to provide greater clarity on the role of dialytic BP on cognitive outcomes. Conclusions Our study reinforces the high frequency of CI in the dialysis population and highlights the importance of evaluating and monitoring cognitive function in this population. Our baseline data did not show an association between dialytic BP measurements and cognitive test performance; however this potential mechanism warrants further investigation due to the limitations of our cross-sectional data. Rigorous studies on the effects of dialysis on cerebral perfusion and the implications for cognitive status are needed in order to fully evaluate the mechanism for cognitive impairment in the dialysis population. Acknowledgments This work was supported by grants from the Medical College of Wisconsin Research Affairs Committee The Froedtert Foundation and the National Center for Advancing Translational Sciences National Institutes of Health through Grant Number 8UL1TR000055. This paper is also the result of work supported with resources and the use of facilities at the Clement J Zablocki VA Medical Center Milwaukee.