Journal Article

Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study

Roodenrys, Steven, Mullan, Judy, Murali, Karumathil M., Cheikh Hassan, Hicham I., Lonergan, Maureen

2021

Overview

Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression [greater than or equal to] 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of 1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage 1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Biology and Life Sciences / Cardiovascular diseases / Cerebrovascular disease / Cerebrovascular diseases / Chronic kidney failure / Cognitive ability / Cohort analysis / Computer programs / Consent / Coronary artery disease / Creatinine / Data collection / Dementia / Diabetes mellitus / Dialysis / Drafting software / Editing / End-stage renal disease / Epidermal growth factor receptors / Ethics / Executive function / Glomerular filtration rate / Health aspects / Heart diseases / Hemodialysis / Hospitals / Hyperlipidemia / Hypertension / Ischemia / Kidney diseases / Kidneys / Lung diseases / Medical records / Medicine / Medicine and Health Sciences / Memory / Methodology / Nephrology / Patient outcomes / Patients / Physical Sciences / Population / Psychological aspects / Psychology / Software / Standard deviation / Toxins / Transplants & implants / Trends / Vascular diseases