Association of Arterial Stiffness and Central Pressure With Cognitive Function in Incident Hemodialysis Patients: The PACE Study.
Association of Arterial Stiffness and Central Pressure With Cognitive Function in Incident Hemodialysis Patients: The PACE Study.
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DOI：
10.1016/j.ekir.2017.07.013
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发表时间：
2017-11
影响因子：
6
通讯作者：
Sozio SM
中科院分区：
文献类型：
--
作者：
Kim ED;Meoni LA;Jaar BG;Shafi T;Linda Kao WH;Estrella MM;Parekh R;Sozio SM
血液透析患者常发生认知障碍，其发病机制可能与血管疾病有关。然而，详细的血管评估与新接受血液透析的患者认知功能的关系尚未得到证实。在一项对入选ESRD心律失常和心血管风险预测因子（PACE）研究的血液透析事件参与者的前瞻性研究中，我们通过脉搏波速度（PWV）确定主动脉僵硬度，通过增强指数（AIx）和中心脉压（cPP）确定全身动脉僵硬度，并检查其与认知处理速度，执行功能，以及通过连线测验A（TMTA）、连线测验B（TMT B）和改良的简易精神状态检查（3 MS）测量的整体认知损害。平均基线年龄为55 ± 13岁，58%为男性，72%为非洲裔美国人，35%患有冠状动脉疾病，55%患有糖尿病，10%患有认知障碍。基线时，较高的PWV和cPP与较长的TMTA相关，较高的PWV与较长的TMTB相关，但在多变量调整后，相关性减弱。1年时，PWV与TMTA、TMTB或3 MS没有独立相关性。然而，未校正和校正分析显示，AIx每增加10%和cPP每增加10 mm Hg与TMTB延长相关（时间差AIx：0.14; 95%置信区间[CI]：0.02 - 0.25对数秒;时间差ecPP：0.11; 95% CI：0.05 - 0.17对数秒）和整体认知功能障碍（比值比[OR]AIx：10.23; 95% CI：1.77−59.00; ORcPP：2.88; 95% CI：1.48−5.59）。较高的AIx和cPP（指示远端血管中的异常波反射）与开始血液透析的患者的认知功能下降相关，并可能导致认知功能下降。
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. 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). 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). 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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