Cognitive impairment is prevalent in patients with end-stage renal disease but it is usually underdiagnosed. Previous studies revealed that cognitive impairment is significantly associated with adverse health outcomes, including ail-cause mortality and hospitalization. The possible etiologies include the high incidence of cerebrovascular diseases, accumulation of uremic toxins, repeating brain ischemic injury caused by intradialytic hypotension, sleep disorders and depression. Medical staff should be alert to signs and symptoms of cognitive impairment, conduct screening neurocognitive testing after treatable factors corrected, and refer patients to neurologists for further assessment and diagnosis whenever necessary. Health care planning should be individualized for patients with cognitive impairment, and lowering dialysate temperature may be considered to prevent intradialytic hypotension. By performing the integration of early diagnosis and intervention, we can improve life quality of the patients and ameliorate enormous burden on care givers, healthcare systems and society.
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