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American Journal of Kidney Diseases

Cognitive Changes in Peritoneal Dialysis Patients: A Multicenter Prospective Cohort Study

      Rationale & Objective

      Cognitive impairment is an independent predictor of technique failure and mortality in patients on peritoneal dialysis (PD) therapy. We investigated changes in cognitive function and factors associated with it in this population.

      Study Design

      Multicenter prospective cohort study.

      Setting & Participants

      458 PD patients were enrolled and followed up for 2 years.

      Predictors

      Global and specific domains of cognitive function were measured at baseline and after 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function; Trail-Making Tests A and B, for executive function; and subtests of the Battery for the Assessment of Neuropsychological Status, for immediate and delayed memory, visuospatial skill, and language ability.

      Outcomes

      The primary outcome was change in cognitive function. Secondary outcomes included all-cause mortality, cardiovascular mortality, hospitalization, and transition to hemodialysis therapy.

      Analytical Approach

      Multivariable linear regression models.

      Results

      The prevalence of cognitive impairment increased from 19.8% to 23.9%. 3MS scores significantly decreased (84.8 to 83.1), although executive function, immediate memory, and visuospatial skill improved over time. Delayed memory capacity and language ability were unchanged. Lower serum albumin level was associated with deteriorated delayed memory, visuospatial skill, and language ability, as well as with the decline in general cognitive function (β values of 0.64, 0.90, 0.80, and 0.44, respectively). Advanced age, lower education, and depression were also correlated with deterioration in general and specific cognitive function. After multivariable adjustment, both global and specific cognitive impairment at baseline were associated with a greater rate of hospitalization, and memory dysfunction was associated with a lower dialysis modality survival rate.

      Limitations

      A relatively short observation period, small number of deaths, and potential selection bias due to patients unavailable for the second assessment.

      Conclusions

      In a PD population, global cognitive function declined over 2 years, though some specific cognitive domains improved. Besides well-recognized factors, hypoalbuminemia and depression were also risk factors for cognitive impairment.

      Index Words

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      References

        • Griva K.
        • Stygall J.
        • Hankins M.
        • Davenport A.
        • Harrison M.
        • Newman S.P.
        Cognitive impairment and 7-year mortality in dialysis patients.
        Am J Kidney Dis. 2010; 56: 693-703
        • Kalirao P.
        • Pederson S.
        • Foley R.N.
        • et al.
        Cognitive impairment in peritoneal dialysis patients.
        Am J Kidney Dis. 2011; 57: 612-620
        • Kurella M.
        • Chertow G.M.
        • Luan J.
        • Yaffe K.
        Cognitive impairment in chronic kidney disease.
        J Am Geriatr Soc. 2004; 52: 1863-1869
        • Kurella M.
        • Mapes D.L.
        • Port F.K.
        • Chertow G.M.
        Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study.
        Nephrol Dial Transplant. 2006; 21: 2543-2548
        • Dong J.
        • Pi H.C.
        • Xiong Z.Y.
        • et al.
        Depression and cognitive impairment in peritoneal dialysis: a multicenter cross-sectional study.
        Am J Kidney Dis. 2015; 67: 111-118
        • Tamura M.K.
        • Yaffe K.
        Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies.
        Kidney Int. 2011; 79: 14-22
        • Etgen T.
        • Chonchol M.
        • Förstl H.
        • Sander D.
        Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis.
        Am J Nephrol. 2012; 35: 474-482
        • Liu G.L.
        • Pi H.C.
        • Hao L.
        • Li D.D.
        • Wu Y.G.
        • Dong J.
        Vitamin D status is an independent risk factor for global cognitive impairment in peritoneal dialysis patients.
        PloS One. 2015; 10: e0143782
        • Xu R.
        • Pi H.C.
        • Xiong Z.Y.
        • et al.
        Hyponatremia and cognitive impairment in patients treated with peritoneal dialysis.
        Clin J Am Soc Nephrol. 2015; 10: 1806-1813
        • McAdams-DeMarco M.A.
        • Tan J.
        • Salter M.L.
        • et al.
        Frailty and cognitive function in incident hemodialysis patients.
        Clin J Am Soc Nephrol. 2015; 10: 2181-2189
        • Smith Jr., S.C.
        • Jackson R.
        • Pearson T.A.
        • et al.
        Principles for national and regional guidelines on cardiovascular disease prevention: a scientific statement from the World Heart and Stroke Forum.
        Circulation. 2004; 109: 3112-3121
        • Teng E.L.
        • Chui H.C.
        The Modified Mini-Mental State (3MS) examination.
        J Clin Psychiatry. 1987; 48: 314-318
        • Kurella M.
        • Chertow G.M.
        • Fried L.F.
        • et al.
        Chronic kidney disease and cognitive impairment in the elderly: the Health, Aging, and Body Composition Study.
        J Am Soc Nephrol. 2005; 16: 2127-2133
        • Lin F.R.
        • Yaffe K.
        • Xia J.
        • et al.
        Hearing loss and cognitive decline in older adults.
        JAMA Intern Med. 2013; 173: 293-299
        • D'Elia L.F.
        • Satz P.
        • Uchiyama C.L.
        • White T.
        Color Trails Test. Professional Manual.
        Psychological Assessment Resources Inc, Odessa, FL1996
        • Yeudall L.T.
        • Reddon J.R.
        • Gill D.M.
        • Stefanyk W.O.
        Normative data for the Halstead-Reitan neuropsychological tests stratified by age and sex.
        J Clin Psychol. 1987; 43: 346-367
        • Randolph C.
        RBANS Manual - Repeatable Battery for the Assessment of Neuropsychological Status.
        The Psychological Corp (Harcourt), San Antonio, TX1998
        • Cheng Y.
        • Wu W.
        • Wang J.
        • Feng W.
        • Wu X.
        • Li C.
        Reliability and validity of the Repeatable Battery for the Assessment of Neuropsychological Status in community-dwelling elderly.
        Arch Med Sci. 2011; 7: 850-857
        • Zhang B.H.
        • Tan Y.L.
        • Zhang W.F.
        • et al.
        The reliability and validity of the Repeatable Battery for the Assessment of Neuropsychological Status.
        Chin Mental Health J. 2008; 22: 865-869
        • Yang G.G.
        • Tian J.
        • Tan Y.L.
        • et al.
        The application performance of the Repeatable Battery for the Assessment of Neuropsychological Status among normal persons in Beijing.
        Chin Mental Health J. 2010; 24: 926-930
        • Zung W.W.
        A self-rating depression scale.
        Arch Gen Psychiatry. 1965; 12: 63-70
        • Netzer N.C.
        • Stoohs R.A.
        • Netzer C.M.
        • Clark K.
        • Strohl K.P.
        Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.
        Ann Intern Med. 1999; 131: 485-491
        • Vignatelli L.
        • Plazzi G.
        • Barbato A.
        • et al.
        Italian version of the Epworth sleepiness scale: external validity.
        Neurol Sci. 2003; 23: 295-300
        • Walters A.S.
        Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group.
        Mov Disord. 1995; 10: 634-642
        • Xu R.
        • Han Q.F.
        • Zhu T.Y.
        • et al.
        Impact of individual and environmental socioeconomic status on peritoneal dialysis outcomes: a retrospective multicenter cohort study.
        PloS One. 2012; 7: e50766
        • Sanchez-Roman S.
        • Ostrosky-Solis F.
        • Morales-Buenrostro L.E.
        • Nogues-Vizcaino M.G.
        • Alberu J.
        • McClintock S.M.
        Neurocognitive profile of an adult sample with chronic kidney disease.
        J Int Neuropsychol Soc. 2011; 17: 80-90
        • Zammit A.R.
        • Katz M.J.
        • Zimmerman M.E.
        • Bitzer M.
        • Lipton R.B.
        Low eGFR is associated with dysexecutive and amnestic mild cognitive impairment.
        Alzheimers Dement (Amst). 2015; 1: 152-159
        • Kurella Tamura M.
        • Unruh M.L.
        • Nissenson A.R.
        • et al.
        Effect of more frequent hemodialysis on cognitive function in the Frequent Hemodialysis Network trials.
        Am J Kidney Dis. 2013; 61: 228-237
        • Neumann D.
        • Mau W.
        • Wienke A.
        • Girndt M.
        Peritoneal dialysis is associated with better cognitive function than hemodialysis over a one-year course.
        Kidney Int. 2018; 93: 430-438
        • Li Y.
        • Tian X.
        • Xiong Z.Y.
        • et al.
        Performance of the Modified Mini-Mental State Examination (3MS) in assessing specific cognitive function in patients undergoing peritoneal dialysis.
        PloS One. 2016; 11: e0166470
        • Van Sandwijk M.S.
        • Ten Berge I.J.
        • Majoie C.B.
        • et al.
        Cognitive changes in chronic kidney disease and after transplantation.
        Transplantation. 2016; 100: 734-742
        • Llewellyn D.J.
        • Langa K.M.
        • Friedland R.P.
        • Lang I.A.
        Serum albumin concentration and cognitive impairment.
        Curr Alzheimer Res. 2010; 7: 91-96
        • Koyama T.
        • Kuriyama N.
        • Ozaki E.
        • et al.
        Serum albumin to globulin ratio is related to cognitive decline via reflection of homeostasis: a nested case-control study.
        BMC Neurol. 2016; 16: 253
        • Friedman A.N.
        • Fadem S.Z.
        Reassessment of albumin as a nutritional marker in kidney disease.
        J Am Soc Nephrol. 2010; 21: 223-230
        • Kurella Tamura M.
        • Larive B.
        • Unruh M.L.
        • et al.
        Prevalence and correlates of cognitive impairment in hemodialysis patients: the Frequent Hemodialysis Network trials.
        Clin J Am Soc Nephrol. 2010; 5: 1429-1438
        • Murray A.M.
        • Tupper D.E.
        • Knopman D.S.
        • et al.
        Cognitive impairment in hemodialysis patients is common.
        Neurology. 2006; 67: 216-223
        • Bruce J.M.
        • Harrington C.J.
        • Foster S.
        • Westervelt H.J.
        Common blood laboratory values are associated with cognition among older inpatients referred for neuropsychological testing.
        Clin Neuropsychol. 2009; 23: 909-925
        • Flicker L.
        • Ames D.
        Metabolic and endocrinological causes of dementia.
        Int Psychogeriatr. 2005; 17: S79-S92
        • Onem Y.
        • Terekeci H.
        • Kucukardali Y.
        • et al.
        Albumin, hemoglobin, body mass index, cognitive and functional performance in elderly persons living in nursing homes.
        Arch Gerontol Geriatr. 2010; 50: 56-59
        • Wilson M.M.
        • Morley J.E.
        Impaired cognitive function and mental performance in mild dehydration.
        Eur J Clin Nutr. 2003; 57: S24-S29
        • Bourdel-Marchasson I.
        • Laksir H.
        • Puget E.
        Interpreting routine biochemistry in those aged over 65 years: a time for change.
        Maturitas. 2010; 66: 39-45
        • Sehgal A.R.
        • Grey S.F.
        • DeOreo P.B.
        • Whitehouse P.J.
        Prevalence, recognition, and implications of mental impairment among hemodialysis patients.
        Am J Kidney Dis. 1997; 30: 41-49
        • Callahan K.E.
        • Lovato J.F.
        • Miller M.E.
        • Easterling D.
        • Snitz B.
        • Williamson J.D.
        Associations between mild cognitive impairment and hospitalization and readmission.
        J Am Geriatr Soc. 2015; 63: 1880-1885
        • Perna L.
        • Wahl H.W.
        • Mons U.
        • Saum K.U.
        • Holleczek B.
        • Brenner H.
        Cognitive impairment, all-cause and cause-specific mortality among non-demented older adults.
        Age Ageing. 2015; 44: 445-451
        • Petersen R.C.
        • Smith G.E.
        • Waring S.C.
        • Ivnik R.J.
        • Tangalos E.G.
        • Kokmen E.
        Mild cognitive impairment: clinical characterization and outcome.
        Arch Neurol. 1999; 56: 303-308