Hemodialysis-based interventions to preserve cognitive function

以血液透析为基础的干预措施以保留认知功能

• 批准号: 10600287
• 负责人: Mara A. McAdams DeMarco
• 金额: $ 54.18万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-09 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10600287
• 关键词: Adult; Anxiety; Cessation of life; Characteristics; Clinical; Cognition; Communities; Country; Dialysis procedure; Digit structure; Educational Intervention; Elderly; End stage renal failure; Enrollment; Ethnic Origin; Fatigue; Frequencies; General Population; Gerontology; Hemodialysis; Hospitalization; Hour; Hypotension; Impairment; Intention; Intervention; Kidney Diseases; Learning; Life; Measures; Mental Depression; Modality; Nephrology; Outcome; Pain interference; Patient Self-Report; Patient-Focused Outcomes; Patients; Physical Function; Provider; Quality of life; Race; Randomized; Randomized Controlled Trials; Renal dialysis; Reporting; Rest; Role; Sleep; Sleep disturbances; Testing; Time; Trail Making Test; Transplantation; adverse outcome; base; cognitive function; cognitive testing; cognitive training; disability; effective intervention; executive function; exercise training; experience; falls; feasibility testing; feasibility trial; functional decline; improved; insight; interest; mental state; mortality; preservation; prevent; primary outcome; secondary outcome; sex; standard of care; tv watching

ABSTRACT Over 640,000 US adults suffer from ESRD, >95% of whom receive hemodialysis (HD) for the rest of their life or until transplantation. Kidney disease and HD significantly impact cognitive function, especially higher-order executive function. Only 13% of HD patients have normal cognition; HD patients experience executive function impairment at a rate 3-fold higher than the general population, leading to hospitalization, disability, and death. Studies of older adults suggest that the only effective interventions for preserving executive function are cognitive training (CT) and/or exercise training (ET). These modalities have not been tested for executive function preservation in HD patients; even younger HD patients suffer substantial executive function impairment and could benefit from these interventions. HD frequency (3 sessions a week) and duration (4-6 hours/session) makes HD patients a “captive audience” for intradialytic CT and/or ET to mitigate executive function decline. In preliminary studies, HD patients reported spending most of their time watching TV; intradialytic CT and/or ET could replace these passive activities. In preliminary studies, 87% of nephrology providers believed that their patients would be interested in intradialytic CT and 83% believed that their patients would be interested in intradialytic ET. Among HD patients, 67% wanted to improve their cognition through CT and 71% wanted to improve their strength and cognition through ET while undergoing HD. To test the feasibility of intradialytic interventions, we conducted a pilot RCT of 20 HD patients, comparing standard of care to CT or ET; even in this pilot, we found that intradialytic CT and ET preserved executive function. As expected, executive function in patients receiving standard of care declined substantially by 3 months (difference=47.4 seconds, P=0.006); however, this decline was not seen among those receiving CT or ET. Compared with standard of care, the difference in mean change was -46.72 seconds (95% CI: -91.12, - 2.31; P=0.04) for CT and -56.21 seconds (95% CI: -105.86, -6.56; P=0.03) for ET. In just 3 months, CT and ET preserved executive function compared to a striking decline with standard of care. To properly test the impact of intradialytic CT and/or ET, on the executive function decline associated with HD, we propose the following aims: 1) To conduct an RCT to evaluate executive function decline in the setting of intradialytic CT and/or ET, 2) To quantify the effects of intradialytic CT and/or ET on ESRD-specific clinical outcomes, 3) To quantify the effects of intradialytic CT and/or ET, on patient-centered outcomes. Through this RCT, we will learn the impact of two potential non-pharmacological interventions, cognitive and exercise training, in preserving executive function during HD. If successful, this will improve HD outcomes of >640,000 adults with ESRD. For the first time, we will have validated, beneficial activities replace the typical passive activities of HD patients. Our findings will be implementable in dialysis centers across the country to help reduce the decline in executive function.

ABSTRACT Over 640,000 US adults suffer from ESRD, >95% of whom receive hemodialysis (HD) for the rest of their life or until transplantation. Kidney disease and HD significantly impact cognitive function, especially higher-order executive function. Only 13% of HD patients have normal cognition; HD patients experience executive function impairment at a rate 3-fold higher than the general population, leading to hospitalization, disability, and death. Studies of older adults suggest that the only effective interventions for preserving executive function are cognitive training (CT) and/or exercise training (ET). These modalities have not been tested for executive function preservation in HD patients; even younger HD patients suffer substantial executive function impairment and could benefit from these interventions. HD frequency (3 sessions a week) and duration (4-6 hours/session) makes HD patients a “captive audience” for intradialytic CT and/or ET to mitigate executive function decline. In preliminary studies, HD patients reported spending most of their time watching TV; intradialytic CT and/or ET could replace these passive activities. In preliminary studies, 87% of nephrology providers believed that their patients would be interested in intradialytic CT and 83% believed that their patients would be interested in intradialytic ET. Among HD patients, 67% wanted to improve their cognition through CT and 71% wanted to improve their strength and cognition through ET while undergoing HD. To test the feasibility of intradialytic interventions, we conducted a pilot RCT of 20 HD patients, comparing standard of care to CT or ET; even in this pilot, we found that intradialytic CT and ET preserved executive function. As expected, executive function in patients receiving standard of care declined substantially by 3 months (difference=47.4 seconds, P=0.006); however, this decline was not seen among those receiving CT or ET. Compared with standard of care, the difference in mean change was -46.72 seconds (95% CI: -91.12, - 2.31; P=0.04) for CT and -56.21 seconds (95% CI: -105.86, -6.56; P=0.03) for ET. In just 3 months, CT and ET preserved executive function compared to a striking decline with standard of care. To properly test the impact of intradialytic CT and/or ET, on the executive function decline associated with HD, we propose the following aims: 1) To conduct an RCT to evaluate executive function decline in the setting of intradialytic CT and/or ET, 2) To quantify the effects of intradialytic CT and/or ET on ESRD-specific clinical outcomes, 3) To quantify the effects of intradialytic CT and/or ET, on patient-centered outcomes. Through this RCT, we will learn the impact of two potential non-pharmacological interventions, cognitive and exercise training, in preserving executive function during HD. If successful, this will improve HD outcomes of >640,000 adults with ESRD. For the first time, we will have validated, beneficial activities replace the typical passive activities of HD patients. Our findings will be implementable in dialysis centers across the country to help reduce the decline in executive function.

项目成果

Racial differences in inflammation and outcomes of aging among kidney transplant candidates.

肾移植候选者之间炎症和衰老结果的种族差异。

• DOI: 10.1186/s12882-019-1360-8
• 发表时间: 2019
• 期刊: BMC nephrology
• 影响因子: 2.3
• 作者: Shrestha,Prakriti;Haugen,ChristineE;Chu,NadiaM;Shaffer,Ashton;Garonzik-Wang,Jacqueline;Norman,SilasP;Walston,JeremyD;Segev,DorryL;McAdams-DeMarco,MaraA
• 通讯作者: McAdams-DeMarco,MaraA

Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments: a prospective cohort study.

视力、听力、身体和行走障碍受者的肾移植结果：一项前瞻性队列研究。

• DOI: 10.1093/ndt/gfz164
• 发表时间: 2020
• 期刊: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
• 作者: Thomas,AlvinG;Ruck,JessicaM;Chu,NadiaM;Agoons,Dayawa;Shaffer,AshtonA;Haugen,ChristineE;Swenor,Bonnielin;Norman,SilasP;Garonzik-Wang,Jacqueline;Segev,DorryL;McAdams-DeMarco,Mara
• 通讯作者: McAdams-DeMarco,Mara

Intradialytic Activities and Health-Related Quality of Life Among Hemodialysis Patients.

血液透析患者的透析中活动和健康相关的生活质量。

• DOI: 10.1159/000492623
• 发表时间: 2018
• 期刊: American journal of nephrology
• 影响因子: 4.2
• 作者: Warsame,Fatima;Ying,Hao;Haugen,ChristineE;Thomas,AlvinG;Crews,DeidraC;Shafi,Tariq;Jaar,Bernard;Chu,NadiaM;Segev,DorryL;McAdams-DeMarco,MaraA
• 通讯作者: McAdams-DeMarco,MaraA

Interventions Made to Preserve Cognitive Function Trial (IMPCT) study protocol: a multi-dialysis center 2x2 factorial randomized controlled trial of intradialytic cognitive and exercise training to preserve cognitive function.

维持认知功能干预试验 (IMPCT) 研究方案：一项多透析中心 2x2 析因随机对照试验，涉及透析中认知和运动训练以维持认知功能。

• DOI: 10.1186/s12882-020-02041-y
• 发表时间: 2020
• 期刊: BMC nephrology
• 影响因子: 2.3
• 作者: McAdams-DeMarco,MaraA;Chu,NadiaM;Steckel,Malu;Kunwar,Sneha;GonzálezFernández,Marlís;Carlson,MichelleC;Fine,DerekM;Appel,LawrenceJ;Diener-West,Marie;Segev,DorryL
• 通讯作者: Segev,DorryL

Delirium, changes in cognitive function, and risk of diagnosed dementia after kidney transplantation.

• DOI: 10.1111/ajt.17176
• 发表时间: 2022-12
• 期刊: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons