Kidney disease doesn’t just affect a patient’s body, it’s hard on their brain too – but no one really knows to what extent.
New research at Kingston Health Sciences Centre (KHSC) is offering intriguing insights into the kidney-brain connection that could change the way that kidney disease is assessed and treated in future.
For the first time, patients on dialysis are being assessed by the KINARM™ to measure the brain effects of kidney disease. KINARM, a state-of-the-art robotic system developed by neuroscientist Dr. Stephen Scott at Queen’s University, precisely measures what’s happening in an individual’s brain or nervous system by testing their ability to perform ordinary movements and tasks.
KINARM was commercialized by Queen’s spin-off, BKIN Technologies, which employs eight people and has sold the KINARM in nearly 60 countries around the world. The system is now in use at all of Kingston’s hospitals to study a wide variety of neurological conditions.
Leading this research is Dr. Gord Boyd, a neurologist and critical care doctor at KHSC who looks at the links between oxygen levels and brain injury in intensive care patients. He says the project was sparked by a casual conversation with Dr. Rachel Holden, a kidney disease specialist at KHSC whose patients are often in intensive care.
“One of the benefits of being in an academic health science centre is that we can collaborate with other specialists to find solutions to the health challenges in our own hospital. In this case, Dr. Holden and I were talking about how to identify oxygenation in the brain, and she suggested that her patients would greatly benefit from this research,” says Dr. Boyd, who is also an Associate Professor of Medicine at Queen’s University.
“While there is some evidence showing that kidney disease, especially in its later stages, can affect some brain functions such as attention and memory, the conventional pen-and-paper tests used to track these effects produce variable and subjective results – and they can’t diagnose the motor effects of brain injury,” says Dr. Boyd.
“There’s no gold-standard test for the effects of kidney disease on brain function, so it’s hard to know the patient’s degree of cognitive impairment,” says Jessica Vanderlinden, a PhD candidate who is working with Dr. Boyd on the project.
Over the past two years Boyd and Vanderlinden have been studying patients on hemodialysis, a four-hour procedure usually done in hospital, and patients on home peritoneal dialysis, a less intensive process that cleanses the blood of the body’s toxins overnight. The patients come to KHSC to participate in KINARM tests before beginning dialysis, then follow-up testing in the KINARM lab at three months and one year.
The researchers will compare patients’ test scores and oxygenation data to study which procedure – hemodialysis or home dialysis – has the better effect on patients’ cognitive function.
They’ve now expanded the scope of their research to include patients at all stages of kidney disease – from mild to moderate, chronic and end stage, which requires dialysis.
They’re also collaborating with Dr. Sam Silver, a nephrologist at KHSC, to include patients with a single episode of acute kidney injury. “No one has ever looked at the brains of this specific group of patients,” Boyd says.
“We’re hoping to come up with a really good description of the neurological complications of kidney disease,” says Ms. Vanderlinden.
This research could provide new insights on treating patients, the researchers say. For example, it could show that hemodialysis itself may need to be re-examined. “If hemodialysis patients have accumulated impairments, how can we make dialysis gentler on the brain? Or it may suggest that we start dialysis sooner, or do transplants sooner,” says Dr. Boyd.
This data can also point to the need for end-of-life conversations. “If we know how much they are impaired, we can develop a plan to start these conversations with them, or if they’re very impaired, with their substitute decision-makers,” Boyd says.
Their work has been sponsored by the Queen’s Department of Medicine Innovation Fund and through equipment donated by the University Hospitals Kingston Foundation.
Feature photo: Dr. Gord Boyd, a critical care doctor, neurologist at KHSC and Associate Professor of Medicine at Queen’s University and Jessica Vanderlinden, PhD candidate at Queen’s University who is working with Dr. Boyd. Photo by M. Manor, KHSC.
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