Evaluation of stress in patients with end stage renal disease – improved cognitive function following renal transplantation

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 50-71-HPA Axis
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-70
Birgit Harbeck*1, Jana Posselt2, Sven Sufke3, Peter Kropp4, Heiner Christian Moenig5, Hendrik Lehnert6 and Christian Stefan Haas3
1University of Lübeck, Lubeck, Germany, 2University of Lübeck, Lübeck, Germany, 3University of Lübeck, 23538, Germany, 4University of Rostock, Rostock, Germany, 5Klinik Chris-Albrechts Univ, Kiel, Germany, 6University Hospital Schleswig-Holstein, Lübeck, Lübeck, Germany
Background: Chronic stress results in hormonal changes, affects cognitive and physical capacities and increases the risk for cardiovascular events. With endocrine functions altered in patients with end stage renal disease, the choice of replacement therapy is thought to have an impact on the overall stress level.

Objective: To evaluate and characterize stress in patients with end stage renal failure treated with hemodialysis or kidney transplantation.  

Methods: In a prospective cohort study, classical physiological (e.g. heart rate variability) and biochemical stress parameters (e.g. cortisol) were assessed in 17 hemodialysis and 18 renal transplant patients. In addition, various tests of attentional performance (TAP) and cognitive function were conducted.

Results:  Hemodialysis patients were comparable with respect to sex (♀ 35 % vs. ♂ 33%, n.s.) and blood pressure (132/79 mmHg vs. 130/78 mmHg, n.s.) but older than patients with a kidney transplant (mean age 63+10 vs. 56+11 years, p<0.05). All patients had a history of hypertension, while diabetes was more common in the hemodialysis group (58.8% vs. 16.7%, p<0.05). As expected, serum cortisol levels were raised in both groups, while insulin and glucagon levels were significantly higher in the dialysis group. On the opposite, cholesterol and low density lipoprotein were significantly higher following renal transplantation. There was neither a significant difference in values for thyroid stimulating hormone, luteinizing hormone, follicle stimulating hormone, growth hormone and testosterone nor did interleukin-6, adrenaline and noradrenaline levels differ between both groups. While heart rate variability was comparable, most attention tests (e.g. digit symbol test, digit span test, word pair test and clock test) showed a tendency of better performance in renal transplant patients with the trail making test A being significantly improved.

Conclusion: We showed that: (1) cognitive functions may improve following renal transplantation; (2) classical biochemical stress parameters are not useful to discriminate stress in patients with chronic kidney disease; and (3) heart rate variability is unaltered in transplant recipients compared to hemodialysis patients. Further studies are required to determine whether age and co-morbidities may affect stress parameters independently from the choice of renal replacement therapy.

Nothing to Disclose: BH, JP, SS, PK, HCM, HL, CSH

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm