The Role of Dialysis in the Pathogenesis and Treatment of Dementia

Dearbhla M. Kelly

Disclosures

Nephrol Dial Transplant. 2019;34(7):1080-1083. 

In This Article

Impact of Blood Pressure

There appears to be a significant influence of midlife hypertension on the progression of cognitive decline.[20] Tight blood pressure control in older adults without kidney disease may be associated with improved cognitive trajectories but blood pressure targets remain controversial in the dialysis cohort.[21,22] Among participants with baseline CKD and hypertension in the SPRINT trial, targeting a systolic blood pressure <120 mmHg compared with <140 mmHg reduced rates of major cardiovascular events and all-cause death.[23] Although some studies have shown a relationship between elevated blood pressure and cognitive impairment in the absence of a stroke, whether intensive hypertension control results in prevention or reversal of cognitive outcomes is unclear.[24] For dialysis patients, several studies have shown that lower blood pressure is related to adverse outcomes including increased mortality, especially in those with old age, Diabetes Mellitus (DM) or cardiovascular complications.[25] In a study of 635 real-world HD sessions in 58 prevalent patients, every 10 mmHg drop from baseline in mean arterial pressure was associated with a 3% increase in ischaemic events and the incidence of ischaemic events rose rapidly below an absolute mean arterial pressure of 60 mmHg.[26] Only 23.5% of HD sessions featured cerebral ischaemia and intradialytic cerebral ischaemia correlated with decreased executive cognitive function at 12 months.

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