Filtering the Evidence: Is There a Cognitive Cost of Hemodialysis?

Conceptual model describing a potential mechanism of cognitive decline due to HD-associated circulatory stress and cerebral hypoperfusion. Boxes A–C depict the risk factors common to patients on dialysis that can lead to impaired cerebral autoregulation. Pairing impaired cerebral autoregulation with the circulatory stress of conventional in-center HD (box D) can lead to downstream events shown in boxes E1–3, with cognitive impairment as the outcome. Box F describes the numerous other non-HD specific factors that can also contribute to cognitive impairment.