Background: Cognitive impairment is highly prevalent in individuals with end stage kidney disease (ESKD) undergoing hemodialysis. The cause is not understood. Our overall hypothesis is that repetitive cerebral hypoperfusion during hemodialysis contributes to accelerated cognitive dysfunction in this patient population. Methods: All participants underwent a baseline assessment with the KINARM, a robotic device that provides quantitative metrics of the sensorimotor control of the upper limb in humans. For patients undergoing hemodialysis, BtO2 was monitored during one dialysis session per week. Follow up KINARM assessment was done at 3 months. Results: To date, 7 patients have completed baseline testing, with 3 being re-evaluated at 3 months. At baseline, patients were impaired on of the 8 tasks, with the exception of a test of working memory. There was a variable correlation between hemodynamics (e.g. blood pressure and heart rate), fluid removal, and BtO2 levels. At 3 months, the 3 patients improved on the majority of the performance metrics assessed with the KINARM. Conclusions: The KINARM is a feasible instrument to measure cognitive dysfunction in individuals with ESKD. In a small cohort, there is improvement in neurocognitive function 3 months after the initiation of dialysis.
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