Cerebral injury in patients on haemodialysis and dementia: the effects of cerebral perfusion and embolisation

Abstract

Thesis title: Cerebral injury in patients on haemodialysis and dementia: the effects of cerebral perfusion and embolisation.Introduction: Stroke and cognitive impairment are types of cerebral injuries (CI) that occur in patients on haemodialysis (HD) and in Alzheimer's disease (AD) and vascular dementia (VaD). Vascular causes of CI include embolisation and defective perfusion. Emboli consisting of particles, clots or bubbles arise from: extracorporeal circulations (EC) during HD and infused intravenously in HD and the arterial tree in AD and VaD. Intravenous emboli during HD may pass into the arterial circulation paradoxically in the presence of a venous to arterial circulation shunt (v-aCS) usually through a patent foramen ovale (PFO). Cerebral embolic signals (CES) are potentially preventable or treatable and perfusion deficits are amenable to appropriate cardiovascular drug modification. The aim of this thesis is to study the interplay of embolisation and haemodynamic factors causing CI and potential ways of treating CI in two seemingly different but closely linked subsets of patients.Methods: I investigated a) paradoxical dialysis induced CES in 54 consecutive patients; b) sources of embolic signals from the extracorporeal circuit in11 patients on HD; c) cerebral haemodynamics and acute changes in cognition during a single HD session in 9 patients d) cerebral blood flow haemodynamics of executive dysfunction in 19 patients with dementia and 19 matched controls; e) the efficacy of potential therapies (Atorvastatin and Clopidogrel) to inhibit CES in 33 patients with AD and VaD and its effects on neuroinflammation.Results: a) embolic signals were detected in the subclavian vein continuously during HD with a median (per 10 min) of 26 at the end of the first hour, rising to 33.5 and 69 at the end of the 2nd and 3rd hours respectively(p

Date of Award	4 Jan 2014
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Charles Mccollum (Main Supervisor) & Sandip Mitra (Co Supervisor)