Table 2.
Evidence, cerebral effects, and cognitive effects of treatment strategies to improve or slow cognitive decline in KFRT.
| Evidence | Summary of Cerebral findings | Summary of cognitive effects | |
|---|---|---|---|
| Lifestyle | |||
| Physical exercise (120, 138) | Randomized controlled trials of cycling, treadmill and exercise classes over 3–12 months. | Improved cerebral blood flow | Improvements in executive function, memory, delayed recall and self-reported cognitive function. |
| Cognitive Training (120) | Randomized trial data of intradialytic tablet-based games | Not assessed | Improvements in psychomotor speed and executive function |
| Medicinal | |||
| Supplements (130) | Cross-over study of valerian supplementation on MMSE score and EEG findings, n = 39. | No changes in EEG between groups | Improved MMSE scores in those taking valerian |
| ESA to correct anemia (131, 139) | Observational data. Use of ESA and effect on cerebral perfusion, oxygen consumption, event related potential and cognitive attention | ESA improves cerebral perfusion and oxygen consumption. Electrophysiology parameters improved with greater Hct (mean 42.8 vs. 31.6%). | Attention improved with higher Hct. The risk of ESA use overshadows potential benefit. |
| Kidney replacement therapy | |||
| Cooled dialysis (48) | Randomized control trial data, n = 73. Measured brain diffusion parameters over 1 year in those receiving dialysis 0.5°C below body temperature. | Diffusion markers stable in those with cooled dialysis. | Cognitive function not assessed. Will be assessed in the pending e-CHECKED trial (122) |
| Renal transplantation (49, 50, 103) | Observational data using cognitive assessment and cerebral imaging before and after transplantation. | Improved diffusion parameters, normalization of neurotransmitters and neural networks as assessed by functional MRI. | Improvements in general cognitive status, psychomotor speed, attention, memory, and abstract thinking have all been reported |
MMSE, mini-mental state examination; EEG, electro-encephalogram; ESA, erythrocyte-stimulating agent; Hct, Hematocrit; e-CHECKED, Evaluation of the Effect of Cooled Hemodialysis on Cognitive Function in Patients Suffering With End-stage Kidney Disease; MRI, magnetic resonance imaging.