Effect of a Single Dialysis on Cognitive Function in Chronic Kidney Disease Stage 5 Hemodialysis Patients

Abstract Background: The incidence of cognitive impairment (CI) has been widely reported in various studies among chronic kidney disease (CKD) patients. Many factors influence cognitive function including hemodialysis (HD) process itself. There is much evidence that a single HD session brings about changes in the cognitive status of patients, but just a few studies assessing whether cognitive performance varies with dialysis. Aim: To know the effect of single dialysis session on cognitive function in HD patients. Method: Sixty medically stable CKD stage 5 patients on HD maintenance at least for three months were enrolled. Cognitive testing performed thrice, 1-2 hour prior dialysis (T1), 3-4 hour into the session (T2) and 24 hour after the session (T3) using a well-validated neuropsychological test battery, Montreal Cognitive Assessment (MoCA) Indonesian version which assess the domain of cognitive function including visuospatial, executive function, naming, memory, attention, language, abstraction, recall, and orientation. Result: among 60 patients complete testing, mean age 45,45 ± 11,28 years, dialysis vintage 10,12 ± 11,88 months, 44 patients (73,3%) had CI at baseline. Cognitive function decline during dialysis (T2) (MoCA INA score 21,65 to 19,67, p < 0.001) and visuospatial, executive function, attention, language and recall was impaired during dialysis. While cognitive function reached its best 24 hour after dialysis (MoCA INA score 23,65, p < 0.001) and all the domain of cognitive function was improved except naming that didn’t change over the dialysis session. Age and dialysis  adequacy were associated with the decline.      Conclusion: There is effect of a single HD session on global cognitive function where cognitive function was deteriorated during HD and reached its best 24 hour after HD. Keywords: cognitive function, chronic kidney disease, hemodialysis