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العنوان
Comparison between hemodialysis and hemodiafiltration regarding effect on cognitive function /
المؤلف
Sayed, Amr Ahmed Mahmoud.
هيئة الاعداد
باحث / Amr Ahmed Mahmoud Sayed
مشرف / Khaled Hussien Hassan Abou Seif
مشرف / Essam Nour El-Din Afify
مناقش / Ahmed Mohamed Tawfik
تاريخ النشر
2019.
عدد الصفحات
110p.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الطب الباطني
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - االباطنة العامة
الفهرس
Only 14 pages are availabe for public view

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Abstract

The number of older patients with ESRD is increasing rapidly worldwide.
The prevalence of CI increased from 19.8% to 23.9%. Advanced age and lower education were correlated with deterioration in cognitive function.
There is increasing recognition that the ‗amyloid-cascade hypothesis‘ cannot fully explain the neuronal damage in Alzheimer‘s disease (AD), and that neuroinflammation plays an important role in the pathogenesis of AD and other neurodegenerative diseases. Since dialysis induces oxidative stress and chronic inflammation, it could be hypothesized that the pro-inflammatory effects of dialysis could also have a negative effect on brain amyloid deposition.
HDF is a dialysis modality that is associated with better hemodynamic stability. A meta-analysis, using the individual patient data from four RCTs, showed better survival in HDF vs. HD patients. The largest benefit was found when a convection volume of > 23 L/session (high-volume) was achieved. The mechanism of the beneficial effect is still unknown, but may be due to superior hemodynamic tolerance with a lower incidence of IDH and a better preservation of the cardiac and cerebrovascular integrity, improved hemodynamic stability with high-volume HDF vs HD treatment results in better preservation
 Summary and Conclusion
(82)
of cerebral perfusion, potentially setting a limit to the accelerated cognitive decline and progression of white matter lesions in ESRD patients. Since high-volume HDF is associated with a significantly better clinical outcome than both standard HDF and HD, it appears that these potential harmful side effects are counterbalanced by dominant beneficial effects, such as a better intradialytic hemodynamic stability and/or a superior clearance of MMW uremic toxins.
The Aβs removal efficiencies were improved by HDF, which enhanced the adsorption of Aβs on micro pores of hollow fibers.
Cognitive assessment using MoCA showed that in HD group: 12 patients were found to have CI and 38 patients were normal, while in HDF group only 4 patients were found to have CI and the other 46 patients had normal cognitive function.
Patients had lower scores on the MoCA than the MMSE when they are combined because executive functions are not assessed in MMSE and MoCA test has more detailed assessment of all cognitive domains. MoCA test could be a difficult test compared to the MMSE.
CI is related to the level of education of patients in all study population; as the percentage of illiterate patients in those with CI was 25% while illiterate patients represented
 Summary and Conclusion
(83)
only 2.4% of those with normal cognitive functions. Also those patients with education > 12 yrs represented 94% of those with normal cognitive functions, while they represented only 62.5% of those with CI.
Among patients in HDF group, CI was related significantly to the age; ages of patients with CI ranges from 55 to 74 yrs, the mean is 66 ± 8.21, while ages in those with normal cognitive function ranges from 22 to 75 yrs, the mean is 49.76 ± 15.1.
CI in HDF group was also related significantly to the history of IHD; 3 patients with CI had history of IHD while only one patient had no history of IHD, while in those with normal cognitive functions, 40 patients didn’t have any history of IHD, 6 patients had history of IHD.
In conclusion, the MoCA test is a valid screening test for CI in both HD patients and HDF patients. It demonstrated higher sensitivity for screening patients with mild CI than MMSE. CI is often under-diagnosed due to the patients‘ unawareness of their cognitive deficits. Therefore, screening tests would be more appropriate for these patients. The MoCA test which is sensitive to executive dysfunction seems to be more adaptable to assess CI in both groups of this study; HD patients and HDF patients