Association of Arterial Stiffness and Central Pressure With Cognitive Function in Incident Hemodialysis Patients: The PACE Study

Esther D. Kim, Lucy Ann Meoni, Bernard Jaar, Tariq Shafi, Wen Hong Linda Kao, Michelle M. Estrella, Rulan Parekh, Stephen M Sozio

Research output: Contribution to journalArticle

Abstract

Introduction Cognitive impairment commonly occurs in hemodialysis patients, with vascular disease potentially implicated in its pathogenesis. However, the relationship of detailed vascular assessment with cognitive function in patients new to hemodialysis has not been demonstrated. Methods In a prospective study of incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD (PACE) study, we determined aortic stiffness by pulse-wave velocity (PWV), systemic arterial stiffness by the augmentation index (AIx) and central pulse pressure (cPP), and examined their associations with cognitive processing speed, executive function, and global cognitive impairment measured by the Trail making test A (TMTA), Trail making test B (TMTB), and the modified Mini-Mental State Exam (3MS). Results Mean baseline age was 55 ± 13 years, 58% were male, 72% were African American, 35% had coronary artery disease, 55% had diabetes, and 10% had cognitive impairment. At baseline, higher PWV and cPP were associated with a longer TMTA, and a higher PWV was associated with a longer TMTB, but the associations were attenuated after multivariable adjustment. At 1 year, PWV was not independently associated with TMTA, TMTB, or 3MS. However, unadjusted and adjusted analyses revealed every 10% increase in AIx and 10 mm Hg increase in cPP were associated with longer TMTB (time differenceAIx: 0.14; 95% confidence interval [CI]: 0.02−0.25 log-seconds; time differencecPP: 0.11; 95% CI: 0.05−0.17 log-seconds) and global cognitive impairment (odds ratio [OR]AIx: 10.23; 95% CI: 1.77−59.00; ORcPP: 2.88; 95% CI: 1.48−5.59). Discussion Higher AIx and cPP, which are indicative of abnormal wave reflections in distal vessels, are associated with, and might contribute to, declining cognitive function in patients starting hemodialysis.

Original languageEnglish (US)
Pages (from-to)1149-1159
Number of pages11
JournalKidney International Reports
Volume2
Issue number6
DOIs
StatePublished - Jan 1 2017

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Trail Making Test
Vascular Stiffness
Cognition
Chronic Kidney Failure
Renal Dialysis
Pulse Wave Analysis
Pressure
Confidence Intervals
Blood Pressure
Social Adjustment
Executive Function
Vascular Diseases
African Americans
Blood Vessels
Coronary Artery Disease
Odds Ratio
Prospective Studies
Cognitive Dysfunction

Keywords

  • arterial stiffness
  • central blood pressure
  • cognitive function
  • end-stage renal disease
  • hemodialysis
  • vascular disease

ASJC Scopus subject areas

  • Nephrology

Cite this

Association of Arterial Stiffness and Central Pressure With Cognitive Function in Incident Hemodialysis Patients : The PACE Study. / Kim, Esther D.; Meoni, Lucy Ann; Jaar, Bernard; Shafi, Tariq; Linda Kao, Wen Hong; Estrella, Michelle M.; Parekh, Rulan; Sozio, Stephen M.

In: Kidney International Reports, Vol. 2, No. 6, 01.01.2017, p. 1149-1159.

Research output: Contribution to journalArticle

Kim, Esther D. ; Meoni, Lucy Ann ; Jaar, Bernard ; Shafi, Tariq ; Linda Kao, Wen Hong ; Estrella, Michelle M. ; Parekh, Rulan ; Sozio, Stephen M. / Association of Arterial Stiffness and Central Pressure With Cognitive Function in Incident Hemodialysis Patients : The PACE Study. In: Kidney International Reports. 2017 ; Vol. 2, No. 6. pp. 1149-1159.
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abstract = "Introduction Cognitive impairment commonly occurs in hemodialysis patients, with vascular disease potentially implicated in its pathogenesis. However, the relationship of detailed vascular assessment with cognitive function in patients new to hemodialysis has not been demonstrated. Methods In a prospective study of incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD (PACE) study, we determined aortic stiffness by pulse-wave velocity (PWV), systemic arterial stiffness by the augmentation index (AIx) and central pulse pressure (cPP), and examined their associations with cognitive processing speed, executive function, and global cognitive impairment measured by the Trail making test A (TMTA), Trail making test B (TMTB), and the modified Mini-Mental State Exam (3MS). Results Mean baseline age was 55 ± 13 years, 58{\%} were male, 72{\%} were African American, 35{\%} had coronary artery disease, 55{\%} had diabetes, and 10{\%} had cognitive impairment. At baseline, higher PWV and cPP were associated with a longer TMTA, and a higher PWV was associated with a longer TMTB, but the associations were attenuated after multivariable adjustment. At 1 year, PWV was not independently associated with TMTA, TMTB, or 3MS. However, unadjusted and adjusted analyses revealed every 10{\%} increase in AIx and 10 mm Hg increase in cPP were associated with longer TMTB (time differenceAIx: 0.14; 95{\%} confidence interval [CI]: 0.02−0.25 log-seconds; time differencecPP: 0.11; 95{\%} CI: 0.05−0.17 log-seconds) and global cognitive impairment (odds ratio [OR]AIx: 10.23; 95{\%} CI: 1.77−59.00; ORcPP: 2.88; 95{\%} CI: 1.48−5.59). Discussion Higher AIx and cPP, which are indicative of abnormal wave reflections in distal vessels, are associated with, and might contribute to, declining cognitive function in patients starting hemodialysis.",
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AU - Shafi, Tariq

AU - Linda Kao, Wen Hong

AU - Estrella, Michelle M.

AU - Parekh, Rulan

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N2 - Introduction Cognitive impairment commonly occurs in hemodialysis patients, with vascular disease potentially implicated in its pathogenesis. However, the relationship of detailed vascular assessment with cognitive function in patients new to hemodialysis has not been demonstrated. Methods In a prospective study of incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD (PACE) study, we determined aortic stiffness by pulse-wave velocity (PWV), systemic arterial stiffness by the augmentation index (AIx) and central pulse pressure (cPP), and examined their associations with cognitive processing speed, executive function, and global cognitive impairment measured by the Trail making test A (TMTA), Trail making test B (TMTB), and the modified Mini-Mental State Exam (3MS). Results Mean baseline age was 55 ± 13 years, 58% were male, 72% were African American, 35% had coronary artery disease, 55% had diabetes, and 10% had cognitive impairment. At baseline, higher PWV and cPP were associated with a longer TMTA, and a higher PWV was associated with a longer TMTB, but the associations were attenuated after multivariable adjustment. At 1 year, PWV was not independently associated with TMTA, TMTB, or 3MS. However, unadjusted and adjusted analyses revealed every 10% increase in AIx and 10 mm Hg increase in cPP were associated with longer TMTB (time differenceAIx: 0.14; 95% confidence interval [CI]: 0.02−0.25 log-seconds; time differencecPP: 0.11; 95% CI: 0.05−0.17 log-seconds) and global cognitive impairment (odds ratio [OR]AIx: 10.23; 95% CI: 1.77−59.00; ORcPP: 2.88; 95% CI: 1.48−5.59). Discussion Higher AIx and cPP, which are indicative of abnormal wave reflections in distal vessels, are associated with, and might contribute to, declining cognitive function in patients starting hemodialysis.

AB - Introduction Cognitive impairment commonly occurs in hemodialysis patients, with vascular disease potentially implicated in its pathogenesis. However, the relationship of detailed vascular assessment with cognitive function in patients new to hemodialysis has not been demonstrated. Methods In a prospective study of incident hemodialysis participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD (PACE) study, we determined aortic stiffness by pulse-wave velocity (PWV), systemic arterial stiffness by the augmentation index (AIx) and central pulse pressure (cPP), and examined their associations with cognitive processing speed, executive function, and global cognitive impairment measured by the Trail making test A (TMTA), Trail making test B (TMTB), and the modified Mini-Mental State Exam (3MS). Results Mean baseline age was 55 ± 13 years, 58% were male, 72% were African American, 35% had coronary artery disease, 55% had diabetes, and 10% had cognitive impairment. At baseline, higher PWV and cPP were associated with a longer TMTA, and a higher PWV was associated with a longer TMTB, but the associations were attenuated after multivariable adjustment. At 1 year, PWV was not independently associated with TMTA, TMTB, or 3MS. However, unadjusted and adjusted analyses revealed every 10% increase in AIx and 10 mm Hg increase in cPP were associated with longer TMTB (time differenceAIx: 0.14; 95% confidence interval [CI]: 0.02−0.25 log-seconds; time differencecPP: 0.11; 95% CI: 0.05−0.17 log-seconds) and global cognitive impairment (odds ratio [OR]AIx: 10.23; 95% CI: 1.77−59.00; ORcPP: 2.88; 95% CI: 1.48−5.59). Discussion Higher AIx and cPP, which are indicative of abnormal wave reflections in distal vessels, are associated with, and might contribute to, declining cognitive function in patients starting hemodialysis.

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