Ischemic brain injury in hemodialysis patients: Which is more dangerous, hypertension or intradialytic hypotension?

TY - JOUR

T1 - Ischemic brain injury in hemodialysis patients

T2 - Which is more dangerous, hypertension or intradialytic hypotension?

AU - McIntyre, Christopher W.

AU - Goldsmith, David J.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Abnormalities of cognitive function and high levels of depression incidence are characteristic of hemodialysis patients. Although previously attributed to the humoral effects of uremia, it is becoming increasingly appreciated that many elements of the overall disease state in CKD patients contribute to functional disturbances and physical brain injury. These factors range from those associated with the underlying primary diseases (cardiovascular, diabetes etc.) to those specifically associated with the requirement for dialysis (including consequences of the hemodialysis process itself). They are, however, predominantly ischemic threats to the integrity of brain tissue. These evolving insights are starting to allow nephrologists to appreciate the potential biological basis of dependency and depression in our patients, as well as develop and test new therapeutic approaches to this increasingly prevalent and important issue. This review aims to summarize the current understanding of brain injury in this setting, as well as examine recent advances being made in the modification of dialysis-associated brain injury.

AB - Abnormalities of cognitive function and high levels of depression incidence are characteristic of hemodialysis patients. Although previously attributed to the humoral effects of uremia, it is becoming increasingly appreciated that many elements of the overall disease state in CKD patients contribute to functional disturbances and physical brain injury. These factors range from those associated with the underlying primary diseases (cardiovascular, diabetes etc.) to those specifically associated with the requirement for dialysis (including consequences of the hemodialysis process itself). They are, however, predominantly ischemic threats to the integrity of brain tissue. These evolving insights are starting to allow nephrologists to appreciate the potential biological basis of dependency and depression in our patients, as well as develop and test new therapeutic approaches to this increasingly prevalent and important issue. This review aims to summarize the current understanding of brain injury in this setting, as well as examine recent advances being made in the modification of dialysis-associated brain injury.

KW - brain injury

KW - hemodialysis

KW - leukoaraiosis

KW - myocardial stunning

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=84930273231&partnerID=8YFLogxK

U2 - 10.1038/ki.2015.62

DO - 10.1038/ki.2015.62

M3 - Literature review

AN - SCOPUS:84930273231

SN - 0085-2538

VL - 87

SP - 1109

EP - 1115

JO - Kidney International

JF - Kidney International

IS - 6

ER -