Quantitative indices of clinical uremia.

The disabling, dialysis-responsive symptoms of clinical uremia primarily represent impaired functions of the nervous system. Accordingly, these studies used several quantitative electrophysiologic and cognition-dependent probes of nervous system function: peripheral nerve-conduction velocity, response latency and amplitude; electroencephalographic (EEG) power-spectrum analysis; visual evoked response latency; EEG responses to photic driving; and measures of integrated behavioral performance that stressed sustained and selective attention, reaction time, speed of decision-making, short-term memory, and mental manipulation of symbols. Probes of quanitified central nervous system function consistently revealed impairments that varied directly with the degree of renal failure, that improved following onset of maintenance dialysis, and that improved still further after successful renal transplantation. In contrast, measures of peripheral nerve function were generally unchanged. Neurobehavioral measures that are relevant to uremic symptomatology provide quantitative estimates of the clinically significant, whole-organism biologic effects of renal failure and its several treatments. Applications of such measures in studies of symptomatic states other than uremia are indicated also.

[1]  J. Kiley,et al.  COMPARISON OF HIGHER BLOOD FLOW HEMODIALYSIS WITH LOWER BLOOD FLOW IN LIGHT OF THE SQUARE METER‐HOUR HYPOTHESIS , 1972, Transactions - American Society for Artificial Internal Organs.

[2]  Schreiner Ge.  Mental and personality changes in the uremic syndrome. , 1959 .

[3]  J. Nunnally.  Introduction to Psychological Measurement , 1970 .

[4]  F. Gotch,et al.  Comparative treatment time with Kiil, Gambro, and Cordis-Dow kidneys. , 1973, Proceedings of the Clinical Dialysis and Transplant Forum.

[5]  L. Cronbach.  Essentials of psychological testing , 1960 .

[6]  B. Scribner,et al.  Clinical impact of residual glomerular filtration rate (GFR) on dialysis time - a preliminary report. , 1974, Transactions - American Society for Artificial Internal Organs.

[7]  H. R. Tyler,et al.  Variations in motor nerve conduction velocity in normal and uremic patients. , 1971, Archives of internal medicine.

[8]  J. W. Ward,et al.  Neurobehavioral responses to "middle molecule" dialysis and transplantation. , 1976, Transactions - American Society for Artificial Internal Organs.

[9]  P. Teschan,et al.  STUDIES IN ACUTE RENAL FAILURE. III. RENAL HISTOLOGIC ALTERATIONS IN ACUTE RENAL FAILURE IN THE RAT. , 1963, The Journal of surgical research.

[10]  Guy J. Groen,et al.  Temporal aspects of simple addition and comparison , 1971 .

[11]  Teschan Pe,et al.  Toxicity of aliphatic amines in uremia. , 1977 .

[12]  R. Kirk.  Experimental Design: Procedures for the Behavioral Sciences , 1970 .

[13]  R. Reitan.  The relation of the trail making test to organic brain damage. , 1955, Journal of consulting psychology.

[14]  Gotch Fa,et al.  The analysis of concentration dependence of uremic lesions in clinical studies. , 1975 .

[15]  D. Regan.  Evoked Potentials in Psychology, Sensory Physiology and Clinical Medicine , 1972 .

[16]  Comparative efficiency of some tests of cerebral damage. , 1963, Journal of consulting psychology.

[17]  R. F. Mayer.  Nerve conduction studies in man , 1963, Neurology.

[18]  H E ROSVOLD,et al.  A continuous performance test of brain damage. , 1956, Journal of consulting psychology.

[19]  F. Gotch,et al.  Studies on the molecular etiology of uremia. , 1975, Kidney international. Supplement.

[20]  B. Scribner,et al.  The genesis of the square meter-hour hypothesis. , 1971, Transactions - American Society for Artificial Internal Organs.

[21]  P. Gloor,et al.  Electroencephalographic changes in chronic renal failure , 1965, Neurology.

[22]  C. Blagg,et al.  Nerve conduction velocity in relationship to the severity of renal disease. , 1968, Nephron.

[23]  R. H. Jebsen,et al.  Natural history of uremic polyneuropathy and effects of dialysis. , 1967, The New England journal of medicine.

[24]  R. E. Marshall,et al.  Fundamentals of Electroencephalography , 1971 .

[25]  G. Glaser,et al.  Metabolic encephalopathy in hepatic, renal and pulmonary disorders. , 1960, Postgraduate medicine.

[26]  J W Ward,et al.  Neurotoxicity in uremia. , 1975, Kidney international. Supplement.

[27]  R. H. Jebsen,et al.  POLYNEUROPATHY IN CHRONIC RENAL INSUFFICIENCY. , 1965, JAMA.

[28]  W. Kolff,et al.  Uremic polyneuropathy: and motor nerve conduction velocities. , 1964, Transactions - American Society for Artificial Internal Organs.

[29]  F. Gotch,et al.  Individualized, quantified dialysis therapy of uremia. , 1974, Proceedings of the Clinical Dialysis and Transplant Forum.

[30]  J. Wishart,et al.  Statistics in Research. , 1956 .

[31]  Jum C. Nunnally,et al.  Educational measurement and evaluation , 1972 .

[32]  B. Scribner,et al.  Quantitative description of dialysis treatment: a dialysis index. , 1975, Kidney international. Supplement.

[33]  J. Alexander,et al.  STUDIES IN ACUTE RENAL FAILURE. I. DEVELOPMENT OF A REPRODUCIBLE LESION IN EXPERIMENTAL ANIMALS. , 1963 .

[34]  J. W. Ward,et al.  Quantitative neurobehavioral responses to renal failure and maintenance dialysis. , 1975, Transactions - American Society for Artificial Internal Organs.

[35]  W. Essman.  Effects of an experimentally induced acute renal failure on a learned maze response in rats. , 1962, The Journal of general psychology.

[36]  Kiley Je,et al.  Techniques of EEG frequency analysis for evaluation of uremic encephalopathy. , 1976 .

[37]  J. W. Ward,et al.  Quantitative assessment of photic driving in renal failure. , 1978, Electroencephalography and clinical neurophysiology.

[38]  George L. Engel,et al.  DELIRIUM: II. REVERSIBILITY OF THE ELECTROENCEPHALOGRAM WITH EXPERIMENTAL PROCEDURES , 1944 .

[39]  Kooi Ka,et al.  Visually evoked cortical responses in renal insufficiency. , 1969 .

[40]  R. Guisado,et al.  Changes in the electroencephalogram in acute uremia. Effects of parathyroid hormone and brain electrolytes. , 1975, The Journal of clinical investigation.

[41]  F M Miezin,et al.  Computer quantification of electroencephalographic data recorded from renal patients. , 1975, Computers and biomedical research, an international journal.

[42]  W. J. Johnson,et al.  Detection and evaluation of uremic peripheral neuropathy in patients on hemodialysis. , 1975, Kidney international. Supplement.

[43]  Kiley Je,et al.  Evaluation of encephalopathy by EEG frequency analysis in chronic dialysis patients. , 1976 .

[44]  John R. Bourne,et al.  Discriminant Analysis of Electroencephalograms Recorded from Renal Patients , 1978, IEEE Transactions on Biomedical Engineering.

[45]  L. G. Fields,et al.  Time perception and hemodialysis. , 1977, Nephron.

[46]  R G Bickford,et al.  The use of on-line telephonic computer analysis of the E.E.G. in anaesthesia. , 1973, British journal of anaesthesia.

[47]  J. W. Ward,et al.  NEUROBEHAVIORAL PROBES FOR ADEQUACY OF DIALYSIS , 1977, Transactions - American Society for Artificial Internal Organs.

[48]  Daniel Silverman.  The Rationale and History of the 10-20 System of the International Federation , 1963 .

[49]  B. Teehan,et al.  Adverse effects of large surface area dialysis on motor nerve conduction velocity. , 1974, Proceedings of the Clinical Dialysis and Transplant Forum.

[50]  George L. Engel,et al.  A SIMPLE METHOD OF DETERMINING FREQUENCY SPECTRUMS IN THE ELECTROENCEPHALOGRAM: OBSERVATIONS ON EFFECTS OF PHYSIOLOGIC VARIATIONS IN DEXTROSE, OXYGEN, POSTURE AND ACID-BASE BALANCE ON THE NORMAL ELECTROENCEPHALOGRAM , 1944 .

[51]  Ginn He.  Neurobehavioral dysfunction in uremia. , 1975 .

[52]  N. Man,et al.  AN APPROACH TO “MIDDLE MOLECULES” IDENTIFICATION IN ARTIFICIAL KIDNEY DIALYSATE, WITH REFERENCE TO NEUROPATHY PREVENTION , 1973, Transactions - American Society for Artificial Internal Organs.

[53]  H. R. Tyler,et al.  Neurologic disorders in renal failure. , 1968, The American journal of medicine.

[54]  J W Ward,et al.  Quantitative assessment of the electroencephalogram in renal disease. , 1975, Electroencephalography and clinical neurophysiology.

[55]  F. N. David,et al.  Principles and procedures of statistics. , 1961 .

[56]  B Hjorth,et al.  EEG and haemodialysis. A structural survey of EEG spectral analysis, Hjorth's EEG descriptors, blood variables and psychological data. , 1977, Electroencephalography and clinical neurophysiology.

[57]  Teschan Pe.  Electroencephalographic and other neurophysiological abnormalities in uremia. , 1975 .

[58]  J. Maher,et al.  Uremia : biochemistry, pathogenesis and treatment , 1961 .

[59]  A. Arieff,et al.  Neurodiagnostic abnormalities in patients with acute renal failure. , 1978, The Journal of clinical investigation.

[60]  P. Teschan.  On the pathogenesis of uremia. , 1970, The American journal of medicine.

[61]  George L. Engel,et al.  DELIRIUM: I. ELECTROENCEPHALOGRAPHIC DATA , 1944 .

[62]  J KILEY,et al.  ELECTROENCEPHALOGRAPHIC EVALUATION OF UREMIA. WAVE FREQUENCY EVALUATIONS ON 40 UREMIC PATIENTS. , 1965, Archives of internal medicine.

[63]  H. Wolff,et al.  The cerebral hemispheres and the highest integrative functions of man. , 1959, Archives of neurology.

[64]  H. R. Tyler,et al.  Neurologic complications of acute uremia. , 1961, Archives of internal medicine.

[65]  J. McDaniel.  Metabolic and CNS correlates of cognitive dysfunction with renal failure. , 1971, Psychophysiology.

[66]  W. J. Johnson,et al.  Uremic neuropathy. III. Controlled study of restricted protein and fluid diet and infrequent hemodialysis versus conventional hemodialysis treatment. , 1975, Mayo Clinic proceedings.

[67]  G. Murphy,et al.  TIMED BEHAVIOR IN PRIMATES DURING VARIOUS EXPERIMENTAL UREMIC STATES. , 1964, The Journal of surgical research.

[68]  T. Sears,et al.  THE RANGE OF CONDUCTION VELOCITY IN NORMAL MOTOR NERVE FIBRES TO THE SMALL MUSCLES OF THE HAND AND FOOT , 1959, Journal of neurology, neurosurgery, and psychiatry.

[69]  H. R. Tyler,et al.  Neurologic disorders seen in the uremic patient. , 1970, Archives of internal medicine.

[70]  H. Mavor,et al.  Motor nerve conduction velocity measurement as a diagnostic tool , 1962, Neurology.