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.

抽象的 超过 640,000 名美国成年人患有 ESRD，其中 >95% 终生接受血液透析 (HD) 或 直到肾病和 HD 显着影响认知功能，尤其是高阶功能。 执行功能 只有 13% 的 HD 患者具有正常的认知功能； 损伤率比一般人群高出 3 倍，导致住院、残疾和死亡。 对老年人的研究表明，保持执行功能的唯一有效干预措施是 认知训练（CT）和/或运动训练（ET）这些方式尚未经过执行测试。 HD 患者的功能保留；甚至年轻的 HD 患者也会遭受显着的执行功能障碍 损伤，并可以从这些干预措施的频率（每周 3 次）和持续时间（4-6 次）中受益。 小时/次）使 HD 患者成为透析中 CT 和/或 ET 的“俘虏观众”，以减轻执行力 初步研究显示，HD 患者大部分时间都在看电视； 在初步研究中，透析内 CT 和/或 ET 可以取代这些被动活动，87% 的肾病学。 提供者相信他们的患者会对透析内 CT 感兴趣，并且 83% 的人相信他们的患者 患者会对透析中 ET 感兴趣。在 HD 患者中，67% 希望提高他们的认知能力。 通过 CT 进行治疗，71% 的人希望在接受 HD 治疗的同时通过 ET 来提高自己的力量和认知能力。 为了测试透析内干预的可行性，我们对 20 名 HD 患者进行了一项试点随机对照试验，比较 CT 或 ET 的护理标准；即使在该试点中，我们也发现透析中 CT 和 ET 保留了执行力 正如预期的那样，接受标准护理的患者的执行功能大幅下降 3。 个月（差异 = 47.4 秒，P = 0.006）；然而，在接受 CT 或 ET. 与标准护理相比，平均变化差异为 -46.72 秒（95% CI：-91.12，- CT 为 2.31；P=0.04），ET 为 -56.21 秒（95% CI：-105.86，-6.56；P=0.03） 在短短 3 个月内，CT 和 ET 均有效。 与护理标准的显着下降相比，执行功能得以保留。 为了正确测试透析中 CT 和/或 ET 对 HD 相关执行功能下降的影响， 我们提出以下目标： 1）进行随机对照试验来评估执行功能下降的情况 透析中 CT 和/或 ET，2) 量化透析中 CT 和/或 ET 对 ESRD 特异性临床的影响 3) 量化透析中 CT 和/或 ET 对以患者为中心的结果的影响。 通过这项随机对照试验，我们将了解两种潜在的非药物干预措施的影响：认知和干预 运动训练，以保持 HD 期间的执行功能。如果成功，这将改善 HD 的结果。 我们将首次为超过 640,000 名患有 ESRD 的成年人提供经过验证的有益活动来取代典型的活动。 我们的研究结果将在全国各地的透析中心实施。 有助于减少执行功能的下降。

项目成果

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。

• 发表时间: 2018
• 影响因子: 4.2
• 作者: Warsame, Fatima;Ying, Hao;Haugen, Christine E;Thomas, Alvin G;Crews, Deidra C;Shafi, Tariq;Jaar, Bernard;Chu, Nadia M;Segev, Dorry L;McAdams
• 通讯作者: McAdams

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。

• 发表时间: 2020-09-03
• 影响因子: 2.3
• 作者: McAdams;Chu, Nadia M;Steckel, Malu;Kunwar, Sneha;González Fernández, Marlís;Carlson, Michelle C;Fine, Derek M;Appel, Lawrence J;Diener;Segev, Dorry L
• 通讯作者: Segev, Dorry L

The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age.

诱导选择导致肾移植后结果的风险因受者年龄而异。

• 发表时间: 2021-07
• 影响因子: 2.3
• 作者: Ahn, JiYoon B;Bae, Sunjae;Chu, Nadia M;Wang, Lingyu;Kim, Jongyeon;Schnitzler, Mark;Hess, Gregory P;Lentine, Krista L;Segev, Dorry L;McAdams
• 通讯作者: McAdams

Long-Term Trajectories of Frailty and Its Components After Kidney Transplantation.

肾移植后衰弱及其组成部分的长期轨迹。

• 发表时间: 2022-12-29
• 作者: Chu, Nadia M;Ruck, Jessica;Chen, Xiaomeng;Xue, Qian;Norman, Silas P;Segev, Dorry L;McAdams
• 通讯作者: McAdams

Trends in Opioid Prescribing Among Hemodialysis Patients, 2007-2014.

2007-2014 年血液透析患者阿片类药物处方趋势。

• 发表时间: 2019
• 影响因子: 4.2
• 作者: Daubresse, Matthew;Alexander, G Caleb;Crews, Deidra C;Segev, Dorry L;McAdams
• 通讯作者: McAdams