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Neuropathy - Exponent of Accelerated Involution in Uremia: The Role of Carbamylation. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2021-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Premature loss of functional integrity of the nervous system in chronic renal failure (CRF) as a consequence of persistent biological activities of the general uremic milieu is almost identical to its structural and functional involution during the process of physiological ageing, but disproportionate and independent of chronological age. In the hyperuremic status of CRF (urea - carbamide), forced carbamylation, as a non-enzymatic post-translational modification (NEPTM) of proteins and amino acids, by changing their biological properties and decreasing proteolysis capacity, represents pathogenetic potential of intensified molecular ageing and accelerated, pathological involution. Physiological predisposition and the exposure of neuropathy before complications of other organs and organ systems in CRF, due to the simultaneous and mutually pathogenetically related uremic lesion and the tissue and vascular segment of the nervous system, direct interest towards proteomic analytical techniques of quantification of carbamylated products as biomarkers of uremic neurotoxicity. Hypothetically, identical to the already established applications of other NEPTM products in practice, they have the potential of clinical methodology in the evaluation of uremic neuropathy and its contribution to the general prediction, but also to the change of the conventional CRF classification. In addition, the identification and therapeutic control of the substrate of accelerated involution, responsible for the amplification of not only neurological but also general degenerative processes in CRF, is attractive in the context of the well-known attitude towards aging.
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Hussain S, Singh A, Antony B, Claure-Del Granado R, Klugarová J, Líčeník R, Klugar M. Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis. J Clin Med 2021; 10:4390. [PMID: 34640408 PMCID: PMC8509598 DOI: 10.3390/jcm10194390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand the association between AKI and dementia risk. A literature search was performed in MEDLINE and Embase databases, from inception to July 2021, to identify epidemiological studies reporting the association between AKI and dementia risk. Title and abstract followed by the full-text of retrieved articles were screened, data were extracted, and quality was assessed, using the Newcastle-Ottawa scale by two investigators independently. The primary outcome was to compute the pooled risk of dementia in AKI patients. Subgroup analysis was also performed based on age and co-morbidities. Certainty of evidence was assessed using the GRADE approach. Statistical analysis was performed using Review Manager 5.4 software. Four studies (cohort (n = 3) and case-control (n = 1)) with a total of 429,211 patients, of which 211,749 had AKI, were identified. The mean age of the patients and the follow-up period were 64.15 ± 16.09 years and 8.9 years, respectively. Included studies were of moderate to high quality. The pooled estimate revealed a significantly higher risk of dementia in AKI patients with an overall relative risk/risk ratio (RR) of 1.92 (95% CI: 1.52-2.43), p ≤ 0.00001. Dementia risk increases by 10% with one year increase in age with an RR of 1.10 (95% CI: 1.09-1.11), p < 0.00001. Subgroup analysis based on stroke as a co-morbid condition also revealed significantly higher dementia risk in AKI patients (RR 2.30 (95% CI: 1.62-3.28), p = 0.009). All-cause mortality risk was also significantly higher in AKI patients with dementia with a pooled RR of 2.11 (95% CI: 1.20-3.70), p = 0.009. The strength of the evidence was of very low certainty as per the GRADE assessment. Patients with AKI have a higher risk of dementia. Further large epidemiological studies are needed to confirm the mechanistic association.
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Affiliation(s)
- Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
| | - Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia; (A.S.); (B.A.)
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia; (A.S.); (B.A.)
| | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2–CNS, Cochabamba, Bolivia;
- Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
| | - Radim Líčeník
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
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Ling TC, Chang CC, Li CY, Sung JM, Sun CY, Tsai KJ, Cheng YY, Wu JL, Kuo YT, Chang YT. Development and validation of the dialysis dementia risk score: A retrospective, population-based, nested case-control study. Eur J Neurol 2021; 29:59-68. [PMID: 34561939 PMCID: PMC9293339 DOI: 10.1111/ene.15123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Background Dementia is prevalent and underdiagnosed in the dialysis population. We aimed to develop and validate a simple dialysis dementia scoring system to facilitate identification of individuals who are at high risk for dementia. Methods We applied a retrospective, nested case‐control study design using a national dialysis cohort derived from the National Health Insurance Research Database in Taiwan. Patients aged between 40 and 80 years were included and 2940 patients with incident dementia were matched to 29,248 non‐dementia controls. All subjects were randomly divided into the derivation and validation sets with a ratio of 4:1. Conditional logistic regression models were used to identify factors contributing to the risk score. The cutoff value of the risk score was determined by Youden's J statistic and the graphic method. Results The dialysis dementia risk score (DDRS) finally included age and 10 comorbidities as risk predictors. The C‐statistic of the model was 0.71 (95% confidence interval [CI] 0.70–0.72). Calibration revealed a strong linear relationship between predicted and observed dementia risk (R2 = 0.99). At a cutoff value of 50 points, the high‐risk patients had an approximately three‐fold increased risk of having dementia compared to those with low risk (odds ratio [OR] 3.03, 95% CI 2.78–3.31). The DDRS performance, including discrimination (C‐statistic 0.71, 95% CI 0.69–0.73) and calibration (p value of Hosmer−Lemeshow test for goodness of fit = 0.18), was acceptable during validation. The OR value (2.82, 95% CI 2.37–3.35) was similar to those in the derivation set. Conclusion The DDRS system has the potential to serve as an easily accessible screening tool to determine the high‐risk groups who deserve subsequent neurological evaluation in daily clinical practice.
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Affiliation(s)
- Tsai-Chieh Ling
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Health, China Medical University, Taichung, Taiwan
| | - Junne-Ming Sung
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yao Sun
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Yun Cheng
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Jia-Ling Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Tzu Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nakamura-Taira N, Horikawa N, Oka F, Igarashi Y, Kobayashi S, Kato S, Enomoto T, Kimura H, Watanabe Y, Kumada T, Matsuyama K, Matsuoka N, Yoshimasu H. Quasi-cluster randomized trial of a six-month low-intensity group-based resistance exercise for hemodialysis patients on depression and cognitive function: a 12-month follow-up. Health Psychol Behav Med 2021; 9:741-760. [PMID: 34484975 PMCID: PMC8409964 DOI: 10.1080/21642850.2021.1966302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective This study aimed to examine the effects of a six-month group-based low-intensity resistance exercise program on depression and the cognitive function of hemodialysis patients. Method We conducted a quasi-cluster randomized, open-label controlled study from October 2017 to December 2018. Forty-two patients undergoing hemodialysis completed the trial over six months; half participated in the resistance exercise group (n = 21, mean = 74.90 years of age, SD = 2.23, 66.67% female) and the other half were in a stretching control group (n = 21, mean = 72.57 years of age, SD = 2.26, 28.57% female). Depressive symptoms and cognitive function were the primary outcome measures. Behavioral and psychological problems associated with cognitive decline (NPI-Q), subjective insomnia, and exercise self-efficacy were secondary outcomes. Outcomes were measured at baseline, three-month (mid-intervention), six-month (end of intervention), and 12-month (six months after intervention) follow-ups. Linear mixed model analyses were used to determine short-term (immediately after intervention) and long-term (six months after intervention) effects. Results In depression, cognitive function, and the NPI-Q, there were no significant effects. In subjective insomnia, a short-term group-by-time interaction in the intervention group compared to the control group was found (ES = .43). However, the effect had disappeared by the 12-month follow-up. In exercise self-efficacy, short- and long-term group-by-time interactions were found. A significant short-term increase in the resistance exercise and a significant decrease in the stretching control was observed (ES = -.83). However, the effect was weakened in the long term (ES = -.38). Conclusion The results showed that low-intensity group resistance exercise would reduce subjective insomnia and improve exercise self-efficacy, but the effect was not maintained by six months after the program. Trial registration: This study was registered on the University Hospital Medical Information Network Clinical Trials Registry (UMIN000029372). Trial registration:UMIN Japan identifier: UMIN000029372.
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Affiliation(s)
- Nanako Nakamura-Taira
- Department of Psychology, Faculty of Letters, Chuo University, Tokyo, Japan.,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Naoshi Horikawa
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Fumie Oka
- Department of Psychiatry and Huntsman Mental Health Institute, University of Utah, UT, USA, UT, USA
| | - Yuri Igarashi
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan.,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shingo Kato
- Yanagihara Rehabilitation Hospital, Tokyo, Japan
| | | | | | | | | | | | | | - Haruo Yoshimasu
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Nicholas P, Green T, Purtell L, Bonner A. A cross-sectional study exploring cognitive impairment in kidney failure. J Ren Care 2021; 48:93-101. [PMID: 34227741 DOI: 10.1111/jorc.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/26/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known of the prevalence or associated factors of cognitive impairment in people with kidney failure. Assessment of cognition is necessary to inform comprehension of healthcare information, aptitude for dialysis modality and informed decision making. OBJECTIVES This study sought to determine the prevalence and factors associated with cognitive impairment in people with kidney failure. DESIGN Prospective cross-sectional. PARTICIPANTS Participants (n = 222) with chronic kidney disease grade 5 (CKD G5) including those not treated with dialysis, those undertaking dialysis independently or in a facility (CKD 5D), and those with a kidney transplant (CKD 5T). MEASUREMENTS Data were collected using the Montreal Cognitive Assessment tool, the Hospital Anxiety and Depression Scale (only the depression subscale), and a demographic questionnaire. Type of kidney disease and comorbidities were extracted from participants' hospital records. RESULTS Participants were 61 ± 13.63 years old; most were male (61.26%), and diabetes was the primary cause of kidney disease (34%). Prevalence of cognitive impairment was 34% although it was significantly higher for those in CKD G5 compared with other groups. A number of factors were found to be associated with cognitive impairment including, age, diabetes, hypertension, education, haemoglobin, albumin, parathyroid hormone, CKD G5, and length of time on treatment. CONCLUSIONS Cognitive impairment in kidney failure is common and it has significant implications for informed decision making and treatment choices. Routine assessment of cognitive function is an important part of clinical practice.
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Affiliation(s)
- Pauline Nicholas
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Theresa Green
- Surgical Treatment and Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, Australia.,School of Nursing, University of Queensland, Brisbane, Australia
| | - Louise Purtell
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.,Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Ann Bonner
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.,Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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56
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Gao T, Ji Y, Wang Y. The effects of dialysis modality choice on cognitive functions in patients with end-stage renal failure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26209. [PMID: 34087894 PMCID: PMC8183726 DOI: 10.1097/md.0000000000026209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is no published meta-analysis comparing the effects of dialysis modality choice on cognitive functions in patients with end-stage renal disease . Therefore, we perform a protocol for systematic review and meta-analysis to evaluate cognitive function in peritoneal dialysis versus hemodialysis patients. METHODS This protocol is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) statement guidelines. Related articles were identified by searching Web of Science, Embase, PubMed, Wanfang Data, Medline, Science Direct, and Cochrane Library. The risk of bias assessment of the included articles was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom). RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION We hypothesized that patients on peritoneal dialysis demonstrated a lower odd of cognitive dysfunction compared to those on hemodialysis. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER 10.17605/OSF.IO/NWCZK.
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57
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Picariello F, Moss-Morris R, Norton S, Macdougall IC, Da Silva-Gane M, Farrington K, Clayton H, Chilcot J. Feasibility Trial of Cognitive Behavioral Therapy for Fatigue in Hemodialysis (BReF Intervention). J Pain Symptom Manage 2021; 61:1234-1246.e5. [PMID: 33068707 DOI: 10.1016/j.jpainsymman.2020.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Fatigue affects at least half of patients who are on hemodialysis (HD) with considerable repercussions on their functioning, quality of life, and clinical outcomes. OBJECTIVES This study assessed the feasibility, acceptability, and potential benefits of a cognitive behavioral therapy intervention for renal fatigue (BReF intervention). METHODS This was a feasibility randomized controlled trial of the BReF intervention vs. waiting-list control. Outcomes included recruitment, retention, and adherence rates. Exploratory estimates of treatment effect were computed. The statistician was blinded to allocation. RESULTS Twenty-four prevalent HD patients experiencing clinical levels of fatigue were individually randomized (1:1) to BReF (N = 12) or waiting-list control arms (N = 12). Fifty-three (16.6%; 95% CI = 12.7-21.1) of 320 patients approached consented and completed the screening questionnaire. It was necessary to approach 13 patients for screening for every one patient randomized. The rate of retention at follow-up was 75% (95% CI = 53.29-90.23). Moderate to large treatment effects were observed in favor of BReF on fatigue severity, fatigue-related functional impairment, depression, and anxiety (standardized mean difference [SMD]g = 0.81; SMDg = 0.93; SMDg = 0.38; SMDg = 0.42, respectively) but not sleep quality (SMDg = -0.31). No trial adverse events occurred. CONCLUSION There was promising evidence in support of the need and benefits of a cognitive behavioral therapy-based intervention for fatigue in HD. However, uptake was low, possibly as a result of an already high treatment burden in this setting. Considerations on the context of delivery are necessary before pursuing a definitive trial.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Maria Da Silva-Gane
- Department of Renal Medicine, Lister Hospital, Stevenage, UK; University of Hertfordshire, Hertfordshire, UK
| | - Ken Farrington
- Department of Renal Medicine, Lister Hospital, Stevenage, UK; University of Hertfordshire, Hertfordshire, UK
| | - Hope Clayton
- Department of Renal Medicine, Lister Hospital, Stevenage, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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58
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YILMAZ DA, YILDIRIM MS, YILDIZ M, OKYAR G. CENTRAL NERVOUS SYSTEM RESPONSE TO CHRONIC KIDNEY DISEASE. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.917658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Due to the aging of the human population, the prevalence of chronic diseases such as chronic kidney disease (CKD) is increasing every year. Chronic kidney disease is a general term that refers to heterogeneous disorders that affect kidney structure and function. Decrease in glomerular filtration can be defined as chronic and progressive deterioration in fluid-solute balance, metabolic and endocrine functions of the kidney. CKD often affects the elderly. With the advancement of age, some structural and functional changes occur in the kidneys. Therefore, the number of patients suffering from mild and moderate CKD is expected to increase in the future.CKD leads to the deep metabolic and hemodynamic changes that damage other organs, such as the heart and brain. CNS abnormalities and cognitive deficits progress with the severity of CBS and occurs mostly among hemodialysis patients. It also has great socio-economic effects on individuals. Since symptoms of CKD are not often found in patients, early recognition of risk factors is the main point. For this reason, it is necessary to identify possible protective and preventive treatments to be applied in at-risk groups and to examine these mechanisms for the treatment of the disease. This review provides available information on the relevant mechanisms.
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Jin M, Wang L, Wang H, Han X, Diao Z, Guo W, Yang Z, Ding H, Wang Z, Zhang P, Zhao P, Lv H, Liu W, Wang Z. Altered resting-state functional networks in patients with hemodialysis: a graph-theoretical based study. Brain Imaging Behav 2021; 15:833-845. [PMID: 32314197 DOI: 10.1007/s11682-020-00293-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent studies have demonstrated that hemodialysis patients exhibit disruptions in functional networks with invisible cerebral alterations. We explored the alterations of functional connectivity in hemodialysis patients using the graph-theory method. A total of 46 hemodialysis patients (53.11 ± 1.58 years, 28 males) and 47 healthy controls (55.57 ± 0.86 years, 22 males) were scanned by using resting-state functional magnetic resonance imaging. The brains of these patients were divided into 90 regions and functional connectivity was constructed with the automatic anatomical labeling atlas. In the defined threshold range, the graph-theory analysis was performed to compare the topological properties including global, regional and edge parameters between the hemodialysis and the healthy control groups. Both hemodialysis patients and healthy control subjects demonstrated common small-world property of the brain functional connections. At the global level, the parameters normalized clustering coefficients and small-worldness were significantly decreased in hemodialysis patients compared with those noted in healthy controls. At the regional level, abnormal nodal metrics (increased or decreased nodal degree, betweenness centrality and efficiency) were widely found in hemodialysis patients compared with those of healthy controls. The network-based statistical method was employed and two disrupted neural circuits with 18 nodes and 19 edges (P = 0.0139, corrected) and 10 nodes and 11 edges (P = 0.0399, corrected) were detected. Of note, the edge-increased functional connectivity was associated with the salience network and the frontal-temporal-basal ganglia connection, whereas the edge-decreased functional connectivity was associated with the frontoparietal network. The graph-theory method may be one of the potential tools to detect disruptions of cerebral functional connectivity and provide important evidence for understanding the neuropathology of hemodialysis patients from the disrupted network organization perspective.
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Affiliation(s)
- Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liyan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Metzger M, Abdel-Rahman EM, Boykin H, Song MK. A Narrative Review of Management Strategies for Common Symptoms in Advanced CKD. Kidney Int Rep 2021; 6:894-904. [PMID: 33912741 PMCID: PMC8071652 DOI: 10.1016/j.ekir.2021.01.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
Patients with advanced chronic kidney disease (CKD) experience multiple bothersome symptoms, undermining their quality of life (QOL). With growing attention to the importance of symptom management in advanced CKD, the evidence regarding symptoms is increasing. In this review, we briefly summarize the current evidence of effective pharmacologic and nonpharmacologic interventions to improve symptoms and QOL in patients with advanced CKD, including those on dialysis. We focused on symptoms that are commonly experienced by patients, such as pain, fatigue, sleep disturbances, itching, nausea and vomiting, cognitive impairment, and anxiety and depression. We noted that research in symptom science focused on improving symptom management in CKD is still very limited. In addition to the lack of clinical practice guidelines to address those common symptoms, the major gaps in the current literature include the evidence regarding mechanistic pathways to inform the development of effective symptom management for CKD populations, the evidence to confirm effective pharmacologic interventions in other populations for CKD populations, and research on how to incorporate effective symptom management approaches into clinical care. Although improving mortality remains as an important area in the kidney community, there is an urgent need to focus on improving symptom management to improve QOL in advanced CKD.
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Affiliation(s)
- Maureen Metzger
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Emaad M. Abdel-Rahman
- Division of Nephrology, Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Heather Boykin
- Kidney Palliative Care Clinic, University of North Carolina Healthcare, UNC Medical Center, Chapel Hill, North Carolina, USA
| | - Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hudgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Guo H, Liu W, Li H, Yang J. Structural and Functional Brain Changes in Hemodialysis Patients with End-Stage Renal Disease: DTI Analysis Results and ALFF Analysis Results. Int J Nephrol Renovasc Dis 2021; 14:77-86. [PMID: 33727853 PMCID: PMC7955761 DOI: 10.2147/ijnrd.s295025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/13/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction The current study aimed to depict intrinsic structural changes and the spontaneous brain activity patterns in voxel level in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) by using diffusion-tensor imaging and resting-state functional magnetic resonance (MR) imaging with an amplitude of low-frequency fluctuations (ALFF) algorithm and their clinical relevance. Materials and Methods In the study, the diffusion-tensor imaging and resting-state functional MR imaging were performed in forty-two hemodialysis patients with ESRD and 42 healthy control subjects. Neuropsychological and laboratory tests were performed in all subjects. ALFF, fraction anisotropy (FA), and mean diffusivity (MD) values were compared between the two groups. Correlations between ALFF, FA or MD values, and clinical markers were analyzed. Results We found that ESRD patients exhibited significantly lower ALFF values in multiple areas, including medial frontal gyrus, limbic lobe, superior frontal gyrus, bilateral lingual gyri, occipital lobe, parahippocampal gyrus, precuneus, while increased ALFF values in medial frontal gyrus than healthy controls. FA values were decreased in medial frontal gyrus, parietal lobe, and left precuneus regions in the ESRD group compared with controls. Importantly, FA for the frontal and parietal lobes was negatively associated with the dialysis duration of ESRD patients, ALFF z-scores for the medial prefrontal cortex (MPFC) were positively correlated with the dialysis duration of ESRD patients and Serum calcium of ESRD patients negatively correlated with FA values in the frontal and parietal lobes (p<0.05). Conclusion Our study revealed that both impaired brain structure and function in ESRD patients with routine hemodialysis distributed mainly in the parietal, temporal, and frontal lobes. ESRD patients have cognitive impairment and declined memory ability. Serum calcium and dialysis duration might be associated with the impairment of brain structure and function in patients with ESRD.
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Affiliation(s)
- Huiying Guo
- Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Wenjin Liu
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Haige Li
- Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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Beckwith HKS, Adwaney A, Appelbe M, Gaffney HT, Hill P, Moabi D, Prout VL, Salisbury E, Webster P, Tomlinson JAP, Brown EA. Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study. Kidney Int Rep 2021; 6:1558-1566. [PMID: 34169196 PMCID: PMC8207314 DOI: 10.1016/j.ekir.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction A better understanding of factors influencing perceived life expectancy (PLE), interactions between patient prognostic beliefs, experiences of illness, and treatment behavior is urgently needed. Methods Case-notes at 3 hemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their health care professionals (HCPs) were invited to complete a structured interview or mixed-methods questionnaire. Four hundred eleven patient notes were screened. Seventy-seven eligible patients were approached and 51 were included. Results Patients predicted significantly higher life expectancies than HCPs (P < 0.0001). Documented cognitive impairment, gender, or increasing age did not affect 1- or 5-year PLE. PLE influenced priorities of care: one-fifth of patients who estimated themselves to have >95% 1-year survival preferred “care focusing on relieving pain and discomfort,” compared with nearly three-quarters of those reporting a ≤50% chance of 1-year survival. Twenty of 51 (39%) patients believed transplantation was an option for them, despite only 4 being waitlisted at the time of the interview. Patients who thought they were transplant candidates were significantly more confident they would be alive at 1 and 5 years and to want resuscitation attempted. Cognitive impairment had no effect on perceived transplant candidacy. A high symptom burden was present and underrecognized by HCPs. High symptom burden was associated with significantly lower PLE at both 1 and 5 years, increased anxiety/depression scores, and treatment choices more likely to prioritize relief of suffering. Conclusion There is a disparity between patient PLE and those of their HCPs. Severity of symptom burden and beliefs regarding PLE or transplant candidacy affect patient treatment preferences.
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Affiliation(s)
- Hannah K S Beckwith
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.,Department of Renal Medicine, Imperial College London, London, United Kingdom
| | - Anamika Adwaney
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Maura Appelbe
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Helen T Gaffney
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Peter Hill
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Dihlabelo Moabi
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Virginia L Prout
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Emma Salisbury
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Phil Webster
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - James A P Tomlinson
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.,Department of Renal Medicine, Imperial College London, London, United Kingdom
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63
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Effect of uremic toxins on hippocampal cell damage: analysis in vitro and in rat model of chronic kidney disease. Heliyon 2021; 7:e06221. [PMID: 33659745 PMCID: PMC7892929 DOI: 10.1016/j.heliyon.2021.e06221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/16/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
One third of the patients with chronic kidney disease (CKD) develop cognitive impairment, which is also an independent risk factor for mortality. However, the concise mechanism of cerebro-renal interaction has not been clarified. The present study examines the effects of uremic toxins on neuronal cells and analyzes the pathological condition of the brain using mouse hippocampal neuronal HT-22 cells and adenine-induced CKD model rats. Among the uremic toxins analyzed, indoxyl sulfate, indole, 3-indoleacetate, and methylglyoxal significantly decreased viability and glutathione level in HT-22 cells. The mixture of these uremic toxins also decreased viability and glutathione level at a lower dose. Adenine-induced CKD rat showed marked renal damage, increased urinary oxidative stress markers, and increased numbers of pyknotic neuronal cells in hippocampus. CKD rats with damaged hippocampus demonstrated poor learning process when tested using the Morris water maze test. Our results suggest that uremic toxins have a toxic effect on hippocampal neuronal cells and uremic CKD rats shows pyknosis in hippocampus.
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64
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Ookawara S, Ito K, Sasabuchi Y, Ueda Y, Hayasaka H, Kofuji M, Uchida T, Horigome K, Aikawa T, Imada S, Minato S, Miyazawa H, Shimoyama H, Hirai K, Watanabe A, Shimoyama H, Morishita Y. Association between Cerebral Oxygenation, as Evaluated with Near-Infrared Spectroscopy, and Cognitive Function in Patients Undergoing Hemodialysis. Nephron Clin Pract 2021; 145:171-178. [PMID: 33556936 DOI: 10.1159/000513327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The prevalence of cognitive impairment in patients undergoing hemodialysis (HD) is higher than that in healthy controls. To date, studies on the association between cognitive function and cerebral oxygenation in these patients are limited. Therefore, in this study, we aimed to cross-sectionally investigate the association between cognitive assessment scores and clinical factors, including cerebral oxygenation, in patients undergoing HD. METHODS In this observational study, 193 HD patients were included. Cerebral regional oxygen saturation (rSO2) was monitored using an INVOS 5,100c oxygen saturation monitor. Poor cognition was defined as a Mini-Mental State Examination (MMSE) score ≤23. We analyzed the association between MMSE score and clinical factors, including cerebral rSO2. RESULTS MMSE score in HD patients included in this study was 26.8 ± 3.3. There were 164 patients (85%) with MMSE score ≥24 and 29 patients (15%) with an MMSE score ≤23. In the patients with MMSE score ≥24, cerebral rSO2 (53.8% ± 8.3%) was significantly higher than that in patients with MMSE score ≤23 (49.5% ± 9.8%; p = 0.013). Multivariable linear regression analysis was performed using the following confounding factors: age, mean blood pressure, cerebral rSO2, HD duration, ultrafiltration rate, hemoglobin, serum Cr, serum calcium, serum phosphate, total cholesterol, high-density lipoprotein cholesterol levels, serum albumin, presence of diabetes mellitus or chronic glomerulonephritis, history of comorbid cardiovascular or cerebrovascular disease, and use of renin-angiotensin-aldosterone system inhibitors or vitamin D analogs. MMSE score was independently and significantly associated with age (standardized coefficient: -0.244) and cerebral rSO2 (standardized coefficient: 0.180). CONCLUSIONS MMSE score was independently associated with age (negative effect) and cerebral rSO2 (positive effect) in this cross-sectional study. Further prospective studies are needed to clarify whether maintaining cerebral oxygenation prevents the deterioration of cognitive function in patients undergoing HD.
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Affiliation(s)
- Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideyuki Hayasaka
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaya Kofuji
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takayuki Uchida
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keita Horigome
- Division of Hemodialysis, Yuai Minuma Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Toshiko Aikawa
- Division of Hemodialysis, Yuai Minuma Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Satoru Imada
- Division of Hemodialysis, Yuai Minuma Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Saori Minato
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirofumi Shimoyama
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akihisa Watanabe
- Division of Hemodialysis, Yuai Minuma Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Hiromi Shimoyama
- Division of Nephrology, Yuai Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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65
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Michna M, Kovarova L, Valerianova A, Malikova H, Weichet J, Malik J. Review of the structural and functional brain changes associated with chronic kidney disease. Physiol Res 2020; 69:1013-1028. [PMID: 33129242 PMCID: PMC8549872 DOI: 10.33549/physiolres.934420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) leads to profound metabolic and hemodynamic changes, which damage other organs, such as heart and brain. The brain abnormalities and cognitive deficit progress with the severity of the CKD and are mostly expressed among hemodialysis patients. They have great socio-economic impact. In this review, we present the current knowledge of involved mechanisms.
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Affiliation(s)
- M Michna
- Department of Radiology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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66
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Cedeño S, Desco M, Aleman Y, Macías N, Fernández-Pena A, Vega A, Abad S, López-Gómez JM. Intradialytic hypotension and relationship with cognitive function and brain morphometry. Clin Kidney J 2020; 14:1156-1164. [PMID: 33841861 PMCID: PMC8023187 DOI: 10.1093/ckj/sfaa070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
Background The haemodynamic stress brought about by dialysis could justify the loss of structural and functional integrity of the central nervous system (CNS). The main objective of this study was to analyse the relationship between intradialytic hypotension (IDH) and cognitive function and brain morphometry. Methods The cross-sectional KIDBRAIN study (Cohort Study of Morphological Changes of the Brain by MRI in Chronic Kidney Disease Patients) included 68 prevalent patients with no history of neurological disorders (cerebrovascular disease and cognitive impairment) undergoing haemodialysis (HD). We analysed 18 non-consecutive dialysis sessions (first three of each month over a 6-month period) and various definitions of IDH were recorded. Global cognitive function (GCF) was assessed using the Mini-Mental State Examination (MMSE) and parameters of structural integrity of the CNS were obtained using volume morphometry magnetic resonance imaging analysis [grey matter (GM), white matter (WM) and hippocampus). Results A greater number of sessions with IDH were associated with less volume of WM (r = −0.359,P = 0.003) and hippocampus (r = −0.395, P = 0.001) independent of cardiovascular risk factors according to multivariable linear regression models (β = −0.198, P = 0.046 for WM; β = −0.253, P = 0.017 for hippocampus). The GCF by the MMSE was 27.3 ± 7.3.1 and was associated with WM volume (β = 0.403, P = 0.001) independent of GM and hippocampus volume. Symptomatic IDH was associated with GCF (r = −0.420, P < 0.001) in adjusted analysis (β = −0.339, P = 0.008). Conclusions Even when asymptomatic, IDH is associated with a lower WM and hippocampus volume and reduced GCF in patients undergoing HD, thus suggesting greater vulnerability of the brain to the haemodynamic stress that may be generated by a dialysis session.
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Affiliation(s)
- Santiago Cedeño
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Yasser Aleman
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Nicolás Macías
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Almudena Vega
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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67
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Tollitt J, Odudu A, Montaldi D, Kalra PA. Cognitive impairment in patients with moderate to severe chronic kidney disease: the Salford kidney cohort study. Clin Kidney J 2020; 14:1639-1648. [PMID: 34084459 PMCID: PMC8162857 DOI: 10.1093/ckj/sfaa178] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Cognitive impairment in chronic kidney disease (CKD) is common and underrecognized [1, 2]. Determining risk factors for cognitive impairment and whether speed of CKD progression is an important consideration may help identify cognitive impairment by nephrologists. Vascular disease is thought to underpin cognitive impairment in CKD and by segregating CKD patients with proven vascular disease, we may also be able to discover other important associations with cognitive impairment in CKD patients. Method A total of 250 patients in a UK prospective cohort of CKD patients underwent two cognitive assessments: Montreal Cognitive Assessment test and Trail Making Test. Cognitive impairment was defined using validated population cut-offs (cognitive impairment) and relative cognitive impairment. Relative cognitive impairment was defined by <1 standard deviation below the mean Z-score on any completed test. Two multivariable logistical regression models identified variables associated with cognitive impairment and realtive cognitive impairment. Results About 44 and 24.8% of patients suffered cognitive impairment and relative cognitive impairment, respectively. Depression, previous stroke and older age were significantly associated with cognitive impairment. Older age was significantly associated with relative cognitive impairment (P ≤ 0.05) and higher proteinuria and the use of psychodynamic medications were also significantly associated with relative cognitive impairment (P = 0.05). Delta estimated glomerular filtration rate (eGFR) in patients with cognitive impairment and relative cognitive impairment compared with those having normal cognition was similar (−0.77 versus −1.35 mL/min/1.73 m2/year, P = 0.34 for cognitive impairment and −1.12 versus −1.02 mL/min/1.73 m2/year, P = 0.89 for relative cognitive impairment). Conclusion Risk factors for cognitive impairment in CKD include previous stroke, depression or anxiety, higher proteinuria and prescription of psychodynamic medications. Patients with a faster eGFR decline do not represent a group of patients at increased risk of cognitive impairment.
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Affiliation(s)
- James Tollitt
- Renal Department, Salford Royal NHS Trust, Salford, UK.,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Aghogho Odudu
- Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK.,Renal Department, Manchester Foundation Trust, Manchester, UK
| | - Daniela Montaldi
- Department for Memory Neurosciences, University of Manchester, Oxford Road, Manchester, UK
| | - Philip A Kalra
- Renal Department, Salford Royal NHS Trust, Salford, UK.,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
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Mutual Interaction of Clinical Factors and Specific microRNAs to Predict Mild Cognitive Impairment in Patients Receiving Hemodialysis. Cells 2020; 9:cells9102303. [PMID: 33076478 PMCID: PMC7650531 DOI: 10.3390/cells9102303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/06/2023] Open
Abstract
Cognitive impairment (CI) is not uncommon in dialysis patients. Various factors have been implicated. This study aims to examine mutual interaction of various clinical factors for CI in patients receiving hemodialysis. A total of 48 hemodialysis patients in outpatient clinic were recruited from 2015 to 2017. Demographics, circulating uremic toxin concentrations, miRNA concentrations, and nerve injury protein concentrations were collected. Clinical dementia rating (CDR) scores were used to stratify the functional scores of the patients. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic test performance for predicting dichotomous results, and cumulative ROC analysis was used to examine the combined contribution of clinical factors. CDR scale 0 included 15 patients (mean age, 59.1 years); CDR > 0.5 included 33 patients (mean age, 64.0 years). On cumulative ROC analysis, the major predictors of mild CI were hemoglobin, age, sex, homocysteine, neuron-specific enolase (NSE), and miR-486. The cumulative area under the curve (AUC) on combining hemoglobin, age, and miR-486 was the highest (0.897, 95% confidence interval 0.806–0.988). Two dichotomized variables reached 81.82% sensitivity and 86.67% specificity, with the likelihood ratio for positive and negative results being 6.14 and 0.21, respectively. In conclusion, hemoglobin, age, and miR-486 display high-degree combined effects on mild CI in patients receiving hemodialysis.
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69
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Murali KM, Lonergan M. Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients. Semin Dial 2020; 33:475-485. [DOI: 10.1111/sdi.12925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Maureen Lonergan
- Department of Nephrology Wollongong Hospital Wollongong NSW Australia
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Comparison of Performance on the Clock Drawing Test Using Three Different Scales in Dialysis Patients. Behav Neurol 2020; 2020:7963837. [PMID: 33029255 PMCID: PMC7527901 DOI: 10.1155/2020/7963837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/26/2023] Open
Abstract
Background The clock drawing test (CDT) is frequently used to detect changes in cognition. Multiple scales of varying length have been published to assess performance. The aim of this study is to compare the CDT performance measured by three scales among a sample of nondemented patients on renal dialysis and identify the variables that affect performance. Methodology. This is a cross-sectional study performed at the dialysis unit at King Saud University Medical City. Eighty-nine dialysis patients performed the CDT. The CDT was scored by the methods of Rouleau et al. (RCS 10-point), Babins et al. (BCS 18-point), and the MoCA (MCS 3-point). Regression models were used to determine influencing demographic and dialysis variables. Scores were then correlated, and a combined factor analysis of scale components was done. Results Females represented 44.6%, the mean (SD) age was 49.99 (15.49) years, and education duration was 10.29 (5.5) years. Dialysis vintage was 55.81 (62.91) months. The scores for the MCS, RCS, and BCS were 2.18 (1.08), 6.67 (3.07), and 11.8 (5.5), respectively, with significant correlation (P < 0.0001). In all scales, increasing age was associated with a lower score (each P < 0.0001). The scores increased with increasing education (each P < 0.0001). Diabetics had a lower score on both the BCS and MCS by 2.56 (SE 1.2) (P = 0.035) and 0.71 (P = 0.003) points, respectively. However, only age and years of education were significant in the multivariable analysis. In factor analysis, two shared factors appeared between the three scales: hand and number placement and the clock face. Conclusion Age and education influence the performance on the CDT, and factors diverged into executive and visuospatial components. The MCS is likely to yield useful information but should be interpreted as part of the MoCA.
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Sedaghat S, Sorond F, Yaffe K, Sidney S, Kramer HJ, Jacobs DR, Launer LJ, Carnethon MR. Decline in kidney function over the course of adulthood and cognitive function in midlife. Neurology 2020; 95:e2389-e2397. [PMID: 32878993 DOI: 10.1212/wnl.0000000000010631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife. METHODS We included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35 years, 54% women, 45% Black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at year (Y) 10 through Y30. At each visit, moderate/high risk of ESRD according to the Kidney Disease: Improving Global Outcomes guidelines (estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin-to-creatinine ratio >30 mg/g) was defined, totaled over examinations, and categorized into 0 episodes, 1 episode, and >1 episodes of ESRD risk. At Y30, participants underwent global and multidomain cognitive assessment. We used analysis of covariance to assess the association of ESRD risk categories with cognitive function, controlling for cardiovascular risk factors. RESULTS Over the course of 20 years, 427 participants (16% of the study population) had ≥1 episodes of ESRD risk exposure. Individuals with more risk episodes had lower composite cognitive function (p < 0.001), psychomotor speed (p < 0.001), and executive function (p = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors. CONCLUSIONS In this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to preserve cognitive function in midlife.
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Affiliation(s)
- Sanaz Sedaghat
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD.
| | - Farzaneh Sorond
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Kristine Yaffe
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Stephen Sidney
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Holly J Kramer
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - David R Jacobs
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Lenore J Launer
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
| | - Mercedes R Carnethon
- From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD
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Chen HJ, Qiu J, Fu Q, Chen F. Alterations of Spontaneous Brain Activity in Hemodialysis Patients. Front Hum Neurosci 2020; 14:278. [PMID: 32765243 PMCID: PMC7381103 DOI: 10.3389/fnhum.2020.00278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is prevalent in hemodialysis end-stage renal disease (ESRD) patients. It might be associated with poor prognosis. Nevertheless, the underlying mechanisms have not been completely clarified. This study explored spontaneous brain activity in ESRD patients on hemodialysis by using the amplitude of low-frequency fluctuation (ALFF). Nineteen ESRD patients on regular hemodialysis were included in this study. Eighteen age-, sex- and education level-matched volunteers were enrolled as the healthy control group. All participants had resting-state functional MRI scanning, neuropsychological tests, and laboratory testing. ALFF was used for assessing intrinsic brain activity. Independent samples t-test was used for obtaining group differences. Spearman correlation analysis was applied to assess the association between ALFF changes, neuropsychological, and clinical indices. Compared to the healthy control group, hemodialysis patients showed decreased ALFF in the precuneus, right angular gyrus/inferior lobule as well as increased ALFF in the left parahippocampus/hippocampus and right precentral/postcentral gyrus. The ALFF abnormalities in these regions were closely associated with hemoglobin levels. Also, increased ALFF in the left parahippocampus/hippocampus showed a negative correlation with the score of long-delayed free recall. Hemodialysis patients had aberrant ALFF in the default mode network (DMN) regions, particularly in the precuneus and parahippocampus/hippocampus, which may be correlated with neuropathological mechanisms involved in hemodialysis.
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Affiliation(s)
- Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jie Qiu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Qingqing Fu
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of University of South China), Haikou, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
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Arai Y, Shioji S, Tanaka H, Kondo I, Sakamoto E, Suzuki M, Katagiri D, Tada M, Hinoshita F. Delirium is independently associated with early mortality in elderly patients starting hemodialysis. Clin Exp Nephrol 2020; 24:1077-1083. [PMID: 32748309 DOI: 10.1007/s10157-020-01941-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/21/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Delirium is an independent predictor of death in patients undergoing dialysis for end-stage renal disease (ESRD). However, it is unknown whether delirium during hospitalization at the start of hemodialysis (HD) in elderly populations is associated with early mortality. METHODS We conducted a retrospective cohort study to investigate the association between delirium and early mortality in the elderly after starting HD. The cohort consisted of patients ≥ 75 years who started dialysis for ESRD at the National Center for Global Health and Medicine from 2010 to 2017 and at Yokosuka Kyosai Hospital from 2007 to 2011. Delirium was defined as patients who showed new symptoms of transient confused thinking and reduced awareness of their environment and were prescribed antipsychotic medications. The primary outcome was death within 1 year. Data were analyzed using Cox proportional hazard models with adjustments for baseline characteristics. A multinomial logistic regression was used to identify the determinants of patients developing delirium. RESULTS We enrolled 259 patients (males, 60%); 33 patients were diagnosed with delirium. The primary outcome was observed in 19 patients with delirium (58%) and 24 patients without delirium (11%) (p < 0.01). Delirium was independently associated with all-cause mortality within 1 year after starting HD (hazard ratio 7.82, 95% confidence interval 4.26-14.3; adjusted hazard ratio 7.16, 95% confidence interval 3.49-14.7). Delirium was positively correlated with "cognitive impairment" as well as "the use of steroids." CONCLUSION Delirium is independently associated with early mortality in the elderly after starting HD.
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Affiliation(s)
- Yohei Arai
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan. .,Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Shingo Shioji
- Department of Nephrology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Hiroyuki Tanaka
- Department of Nephrology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Isao Kondo
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan
| | - Emi Sakamoto
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan
| | - Minami Suzuki
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan
| | - Daisuke Katagiri
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan
| | - Manami Tada
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan
| | - Fumihiko Hinoshita
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-3655, Japan
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74
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Park BS, Lee HW, Lee YJ, Park S, Kim YW, Kim SE, Kim IH, Park JH, Park KM. Serum S100B represents a biomarker for cognitive impairment in patients with end-stage renal disease. Clin Neurol Neurosurg 2020; 195:105902. [DOI: 10.1016/j.clineuro.2020.105902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
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Li Y, Pi HC, Yang ZK, Dong J. Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis. J Nephrol 2020; 33:839-848. [PMID: 31643008 PMCID: PMC7381472 DOI: 10.1007/s40620-019-00661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Uremic toxins have been suspected as potential contributors for cognitive impairment in peritoneal dialysis (PD) patients. However, associations between the clearance of serum small and middle molecules and the change of cognitive function were not fully explored and then we explored this issue in the present study. METHOD A total of clinically-stable 222 patients on PD were enrolled and then followed up for 2 years in this single-center prospective cohort study. Small and middle molecules clearances were examined by urea clearance (Kt/V), creatinine clearance (Ccr) and beta-2 microglobulin (B2M) clearance via dialysate and urine at baseline and after 2 years. Global and specific cognitive impairment were measured at baseline and after 2 years. Modified Mini-Mental State Examination (3MS) was assessed for 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 skills and language ability. RESULTS The median of total Kt/V, Ccr and B2M clearance were 1.89, 53.2 l/w/1.73 m2 and 17.5 l/w/1.73 m2, respectively at baseline. The prevalence of global cognitive impairment was 12.3% for 222 patients and 15.4% for the remained 130 patients after 2 years. At baseline, total Kt/V was independently positively associated with delayed memory function. Total and dialysate beta-2 microglobulin clearance was positively associated with 3MS scores and negatively with completion time on trail A after multivariate adjustment. At 2 years, we observed a significant difference in the changing trend of 3MS scores between groups divided by total B2M clearance (P = 0.033), which still maintained to be meaningful after multivariate adjustment (P = 0.024). Patients with total B2M clearance > 19.0 l/w/1.73 m2 got significant improvement on their 3MS scores (P = 0.005). Patients divided by total Kt/V or Ccr were not significantly different in the trends of general and any specific cognitive function during the follow up. CONCLUSION The higher middle molecules clearance independently correlated to better performance on general cognitive and executive function in PD patients, which also predict an improvement in general cognitive function during the follow up.
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Affiliation(s)
- Yi Li
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
- Renal Division, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hai-Chen Pi
- Emergency Department, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China.
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Kwan E, Draper B, Endre ZH, Harvey SB, Brown MA. Prevalence, Types and Recognition of Cognitive Impairment in Dialysis Patients in South Eastern Sydney. Intern Med J 2020; 51:2034-2041. [PMID: 32672898 DOI: 10.1111/imj.14976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In international studies, cognitive impairment is a common but underdetected issue in dialysis patients. Chronic Kidney Disease (CKD) shares risk factors with and is an independent risk factor for cognitive impairment. There is a lack of Australian data of cognitive impairment in this at-risk population. This has implications on service planning because cognitive impairment in CKD is associated with higher mortality, morbidity, and healthcare costs. AIMS This study examines the prevalence, types, and clinician recognition of cognitive impairment within an Australian dialysis population. METHODS A cross-sectional study of haemodialysis and peritoneal dialysis patients in South-East Sydney screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Participant interviews, medical records, physician and carer questionnaires, were used to determine the types of cognitive impairment and rate of recognition. RESULTS 106 participants were included (median age 66 years, median dialysis duration 2 years) and 58 (54.7%) were cognitively impaired on the MoCA, of whom old age psychiatrists subclassified 21 (36.2%) as having dementia, and 31 (53.4%) with 'Cognitive Impairment, No Dementia'. 36/58 (62.0%) of the cognitively impaired participants on the MoCA were suspected of having cognitive impairment by nephrologists but only 14/58 (24.1%) had this documented in medical records. CONCLUSION Although cognitive impairment is common in dialysis patients, there are low levels of detection by clinical teams. Cognitive screening of dialysis patients should be incorporated as part of wider assessment and determination of management goals such as individuals' capacity to self-care and provide informed consent to treatments. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elaine Kwan
- School of Psychiatry, UNSW Sydney, Australia
| | | | | | | | - Mark A Brown
- St George & Sutherland Clinical School, UNSW Sydney, Australia
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Chu NM, Shi Z, Haugen CE, Norman SP, Gross AL, Brennan DC, Carlson MC, Segev DL, McAdams-DeMarco MA. Cognitive Function, Access to Kidney Transplantation, and Waitlist Mortality Among Kidney Transplant Candidates With or Without Diabetes. Am J Kidney Dis 2020; 76:72-81. [PMID: 32029264 PMCID: PMC7311233 DOI: 10.1053/j.ajkd.2019.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/31/2019] [Indexed: 12/21/2022]
Abstract
RATIONALE & OBJECTIVE Intact cognition is generally a prerequisite for navigating through and completing evaluation for kidney transplantation. Despite kidney transplantation being contraindicated for those with severe dementia, screening for more mild forms of cognitive impairment before referral is rare. Candidates may have unrecognized cognitive impairment, which may prolong evaluation, elevate mortality risk, and hinder access to kidney transplantation. We estimated the burden of cognitive impairment and its association with access to kidney transplantation and waitlist mortality. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,630 participants (January 2009 to June 2018) with cognitive function measured (by the Modified Mini-Mental State Examination [3MS]) at kidney transplantation evaluation at 1 of 2 transplantation centers. PREDICTORS Cognitive impairment (3MS score<80). OUTCOMES Listing, waitlist mortality, and kidney transplantation. ANALYTICAL APPROACH We estimated the adjusted chance of listing (Cox regression), risk for waitlist mortality (competing-risks regression), and kidney transplantation rate (Poisson regression) by cognitive impairment. Given potential differences in cause of cognitive impairment among those with and without diabetes, we tested whether these associations differed by diabetes status using a Wald test. RESULTS At evaluation, 6.4% of participants had cognitive impairment, which was independently associated with 25% lower chance of listing (adjusted HR, 0.75; 95% CI, 0.61-0.91); this association did not differ by diabetes status (Pinteraction=0.07). There was a nominal difference by diabetes status for the association between cognitive impairment and kidney transplantation rate (Pinteraction=0.05), while the association between cognitive impairment and waitlist mortality differed by diabetes status kidney transplantation rates (Pinteraction=0.02). Among candidates without diabetes, those with cognitive impairment were at 2.47 (95% CI, 1.31-4.66) times greater risk for waitlist mortality; cognitive impairment was not associated with this outcome among candidates with diabetes. LIMITATIONS Single measure of cognitive impairment. CONCLUSIONS Cognitive impairment is associated with a lower chance of being placed on the waitlist, and among patients without diabetes, with increased mortality on the waitlist. Future studies should investigate whether implementation of screening for cognitive impairment improves these outcomes.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Zhan Shi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Silas P Norman
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel C Brennan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michelle C Carlson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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Jin M, Wang L, Wang H, Han X, Diao Z, Guo W, Yang Z, Ding H, Wang Z, Zhang P, Zhao P, Lv H, Liu W, Wang Z. Disturbed neurovascular coupling in hemodialysis patients. PeerJ 2020; 8:e8989. [PMID: 32328355 PMCID: PMC7166048 DOI: 10.7717/peerj.8989] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Altered cerebral blood flow (CBF) and amplitude of low-frequency fluctuation (ALFF) have been reported in hemodialysis patients. However, neurovascular coupling impairments, which provide a novel insight into the human brain, have not been reported in hemodialysis patients. Methods We combined arterial spin labeling (ASL) and blood oxygen level dependent (BOLD) techniques to investigate neurovascular coupling alterations and its relationships with demographic and clinical data in 46 hemodialysis patients and 47 healthy controls. To explore regional neuronal activity, ALFF was obtained from resting-state functional MRI. To measure cerebral vascular response, CBF was calculated from ASL. The across-voxel CBF-ALFF correlations for global neurovascular coupling and CBF/ALFF ratio for regional neurovascular coupling were compared between hemodialysis patients and healthy controls. Two-sample t-tests were used to compare the intergroup differences in CBF and ALFF. Multiple comparisons were corrected using a voxel-wise false discovery rate (FDR) method (P < 0.05). Results All hemodialysis patients and healthy controls showed significant across-voxel correlations between CBF and ALFF. Hemodialysis patients showed a significantly reduced global CBF-ALFF coupling (P = 0.0011) compared to healthy controls at the voxel-level. Of note, decreased CBF/ALFF ratio was exclusively located in the bilateral amygdala involved in emotional regulation and cognitive processing in hemodialysis patients. In hemodialysis patients, the decreased CBF (right olfactory cortex, anterior cingulate gyrus and bilateral insula) and ALFF (bilateral precuneus and superior frontal gyrus) were mainly located in the default mode network and salience network-related regions as well as increased CBF in the bilateral thalamus. Conclusions These novel findings reveal that disrupted neurovascular coupling may be a potential neural mechanism in hemodialysis patients.
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Affiliation(s)
- Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liyan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Wu PH, Lin YT, Chen CS, Chiu YW, Tsai JC, Kuo PL, Hsu YL, Ljunggren Ö, Fellström B, Kuo MC. Associations of Bone Turnover Markers with Cognitive Function in Patients Undergoing Hemodialysis. DISEASE MARKERS 2020; 2020:8641749. [PMID: 32377274 PMCID: PMC7196142 DOI: 10.1155/2020/8641749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/16/2020] [Accepted: 01/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients undergoing hemodialysis experience a greater risk of cognitive impairment than the general population, but limited data elucidates the biomarkers on this. We evaluated the association of bone turnover markers on cognitive function among 251 prevalent hemodialysis enrollees in a cross-sectional study. METHODS 251 hemodialysis patients (median age = 57.8, 55% men) and 37 control subjects (mean age = 61.2, 56% men) without a prior stroke or dementia diagnosis were enrolled. Serum concentrations of 8 bone markers were analyzed as the association of cognitive function (Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI)) using linear regression analysis. RESULTS A lower cognitive function was noted in hemodialysis patients compared to control subjects. The receptor activator of nuclear factor kappa-B ligand (RANKL) was the only bone marker found to be associated with cognitive function (MoCA and CASI tests) in hemodialysis patients without a prior stroke or dementia diagnosis. In stepwise multiple linear regression analysis, the association remained significant in MoCA (β = 1.14, 95% CI 0.17 to 2.11) and CASI (β = 3.06, 95% CI 0.24 to 5.88). Short-term memory (β = 0.52, 95% CI 0.01 to 1.02), mental manipulation (β = 0.51, 95% CI 0.05 to 0.96), and abstract thinking (β = 0.57, 95% CI 0.06 to 1.09) were the significant subdomains in the CASI score related to RANKL. CONCLUSIONS Serum RANKL levels were potentially associated with better cognitive function in hemodialysis patients. Further large-scale and prospective studies are needed to confirm our findings.
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Affiliation(s)
- Ping-Hsun Wu
- Graduate Institute of Clinical Medicine, College of Medicines, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Yi-Ting Lin
- Graduate Institute of Clinical Medicine, College of Medicines, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Lin Kuo
- Graduate Institute of Clinical Medicine, College of Medicines, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ling Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Fellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mei-Chuan Kuo
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Harnessing digital health to objectively assess cognitive impairment in people undergoing hemodialysis process: The Impact of cognitive impairment on mobility performance measured by wearables. PLoS One 2020; 15:e0225358. [PMID: 32310944 PMCID: PMC7170239 DOI: 10.1371/journal.pone.0225358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Abstract
Cognitive impairment is prevalent but still poorly diagnosed in hemodialysis adults, mainly because of the impracticality of current tools. This study examined whether remotely monitoring mobility performance can help identifying digital measures of cognitive impairment in hemodialysis patients. Sixty-nine diabetes mellitus hemodialysis patients (age = 64.1±8.1years, body mass index = 31.7±7.6kg/m2) were recruited. According to the Mini-Mental State Exam, 44 (64%) were determined as cognitive-intact, and 25 (36%) as cognitive-impaired. Mobility performance, including cumulated posture duration (sitting, lying, standing, and walking), daily walking performance (step and unbroken walking bout), as well as postural-transition (daily number and average duration), were measured using a validated pendant-sensor for a continuous period of 24-hour during a non-dialysis day. Motor capacity was quantified by assessing standing balance and gait performance under single-task and dual-task conditions. No between-group difference was observed for the motor capacity. However, the mobility performance was different between groups. The cognitive-impaired group spent significantly higher percentage of time in sitting and lying (Cohens effect size d = 0.78, p = 0.005) but took significantly less daily steps (d = 0.69, p = 0.015) than the cognitive-intact group. The largest effect of reduction in number of postural-transition was observed in walk-to-sit transition (d = 0.65, p = 0.020). Regression models based on demographics, addition of daily walking performance, and addition of other mobility performance metrics, led to area-under-curves of 0.76, 0.78, and 0.93, respectively, for discriminating cognitive-impaired cases. This study suggests that mobility performance metrics could be served as potential digital biomarkers of cognitive impairment among hemodialysis patients. It also highlights the additional value of measuring cumulated posture duration and postural-transition to improve the detection of cognitive impairment. Future studies need to examine potential benefits of mobility performance metrics for early diagnosis of cognitive impairment/dementia and timely intervention.
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81
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Renal transplantation in the elderly: Outcomes and recommendations. Transplant Rev (Orlando) 2020; 34:100530. [DOI: 10.1016/j.trre.2020.100530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/09/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
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82
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Viggiano D, Wagner CA, Martino G, Nedergaard M, Zoccali C, Unwin R, Capasso G. Mechanisms of cognitive dysfunction in CKD. Nat Rev Nephrol 2020; 16:452-469. [PMID: 32235904 DOI: 10.1038/s41581-020-0266-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is an increasingly recognized major cause of chronic disability and is commonly found in patients with chronic kidney disease (CKD). Knowledge of the relationship between kidney dysfunction and impaired cognition may improve our understanding of other forms of cognitive dysfunction. Patients with CKD are at an increased risk (compared with the general population) of both dementia and its prodrome, mild cognitive impairment (MCI), which are characterized by deficits in executive functions, memory and attention. Brain imaging in patients with CKD has revealed damage to white matter in the prefrontal cortex and, in animal models, in the subcortical monoaminergic and cholinergic systems, accompanied by widespread macrovascular and microvascular damage. Unfortunately, current interventions that target cardiovascular risk factors (such as anti-hypertensive drugs, anti-platelet agents and statins) seem to have little or no effect on CKD-associated MCI, suggesting that the accumulation of uraemic neurotoxins may be more important than disturbed haemodynamic factors or lipid metabolism in MCI pathogenesis. Experimental models show that the brain monoaminergic system is susceptible to uraemic neurotoxins and that this system is responsible for the altered sleep pattern commonly observed in patients with CKD. Neural progenitor cells and the glymphatic system, which are important in Alzheimer disease pathogenesis, may also be involved in CKD-associated MCI. More detailed study of CKD-associated MCI is needed to fully understand its clinical relevance, underlying pathophysiology, possible means of early diagnosis and prevention, and whether there may be novel approaches and potential therapies with wider application to this and other forms of cognitive decline.
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Affiliation(s)
- Davide Viggiano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Biogem Scarl, Ariano Irpino, Italy
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland, and National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Gianvito Martino
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maiken Nedergaard
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, USA
| | - Carmine Zoccali
- Institute of Clinical Physiology, National Research Council (CNR), Reggio Calabria Unit, Reggio Calabria, Italy
| | - Robert Unwin
- Department of Renal Medicine, University College London (UCL), Royal Free Campus, London, UK.,Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. .,Biogem Scarl, Ariano Irpino, Italy.
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83
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Drew DA, Tighiouart H, Rollins J, Duncan S, Babroudi S, Scott T, Weiner DE, Sarnak MJ. Evaluation of Screening Tests for Cognitive Impairment in Patients Receiving Maintenance Hemodialysis. J Am Soc Nephrol 2020; 31:855-864. [PMID: 32132197 DOI: 10.1681/asn.2019100988] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/10/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Neurocognitive testing shows that cognitive impairment is common among patients receiving maintenance hemodialysis. Identification of a well performing screening test for cognitive impairment might allow for broader assessment in dialysis facilities and thus optimal delivery of education and medical management. METHODS From 2015 to 2018, in a cohort of 150 patients on hemodialysis, we performed a set of comprehensive neurocognitive tests that included the cognitive domains of memory, attention, and executive function to classify whether participants had normal cognitive function versus mild, moderate, or severe cognitive impairment. Using area-under-the-curve (AUC) analysis, we then examined the predictive ability of the Mini Mental State Examination, the Modified Mini Mental State Examination, the Montreal Cognitive Assessment, the Trail Making Test Part B, the Mini-Cog test, and the Digit Symbol Substitution Test, determining each test's performance for identifying severe cognitive impairment. RESULTS Mean age was 64 years; 61% were men, 39% were black, and 94% had at least a high-school education. Of the 150 participants, 21% had normal cognitive function, 17% had mild cognitive impairment, 33% had moderate impairment, and 29% had severe impairment. The Montreal Cognitive Assessment had the highest overall predictive ability for severe cognitive impairment (AUC, 0.81); a score of ≤21 had a sensitivity of 86% and specificity of 55% for severe impairment, with a negative predictive value of 91%. The Trails B and Digit Symbol tests also performed reasonably well (AUCs, 0.73 and 0.78, respectively). The other tests had lower predictive performances. CONCLUSIONS The Montreal Cognitive Assessment, a widely available and brief cognitive screening tool, showed high sensitivity and moderate specificity in detecting severe cognitive impairment in patients on maintenance hemodialysis.
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Affiliation(s)
- David A Drew
- Division of Nephrology, Department of Medicine, and
| | - Hocine Tighiouart
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Tufts Clinical and Translational Science Institute, and
| | | | - Sarah Duncan
- Division of Nephrology, Department of Medicine, and
| | | | - Tammy Scott
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
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84
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Zhang J, Tang L, Hu J, Wang Y, Xu Y. Uric acid is associated with cognitive impairment in the elderly patients receiving maintenance hemodialysis-A two-center study. Brain Behav 2020; 10:e01542. [PMID: 31985179 PMCID: PMC7066348 DOI: 10.1002/brb3.1542] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Elevated serum uric acid (SUA) has been associated with vascular cognitive impairment (CI) in the elderly. However, its relationship with cognitive function in the elderly patients receiving maintenance hemodialysis (MHD) has not yet been elucidated. OBJECTIVE The cognitive impairment is prevalent in MHD patients. Various insults may contribute to cognitive impairment in patients with MHD. The aim of this study was to investigate the relationship between SUA and CI in the elderly patients receiving MHD. METHODS A total of 180 elderly MHD subjects from two hospitals were enrolled in our study. Cognitive function domains were evaluated by MMSE at the beginning of the trial. Demographic and clinical characteristics were collected and recorded. RESULTS The subjects were stratified into quartiles according to SUA level. Demographic and clinical characteristics such as age, gender, smoking habit, education year, blood pressure (BP), hemoglobin, albumin, blood glucose (BG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), blood urea nitrogen (BUN), and serum creatinine (Scr) did not differ dramatically among groups (p > .05). The Q1 group showed the highest MMSE scores, and the Q4 group showed the lowest MMSE sores (p < .05). There was a negative correlation between SUA and MMSE scores (r = -.307, p = .014), and this correlation was independent of demographic and clinical characteristics. CONCLUSIONS Elevated SUA maybe contributes to CI in the elderly MHD patients. SUA level is independent risk for the CI in the elderly MHD patients.
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Affiliation(s)
- Jing Zhang
- Department of Nephrology, Wannan Medical College Affiliated Yijishan Hospital, Wuhu, China
| | - Lijuan Tang
- Department of Nephrology, Wuhu Second People's Hospital, Wuhu, China
| | - Jun Hu
- Blood Purification Center, Wannan Medical College Affiliated Yijishan Hospital, Wuhu, China
| | - Yuwei Wang
- Department of Nephrology, Wannan Medical College Affiliated Yijishan Hospital, Wuhu, China
| | - Yuzhen Xu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.,Department of Neurology, Taian City Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
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85
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Shinjyo N, Parkinson J, Bell J, Katsuno T, Bligh A. Berberine for prevention of dementia associated with diabetes and its comorbidities: A systematic review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:125-151. [PMID: 32005442 DOI: 10.1016/j.joim.2020.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND A growing number of epidemiological studies indicate that metabolic syndrome (MetS) and its associated features play a key role in the development of certain degenerative brain disorders, including Alzheimer's disease and vascular dementia. Produced by several different medicinal plants, berberine is a bioactive alkaloid with a wide range of pharmacological effects, including antidiabetic effects. However, it is not clear whether berberine could prevent the development of dementia in association with diabetes. OBJECTIVE To give an overview of the therapeutic potential of berberine as a treatment for dementia associated with diabetes. SEARCH STRATEGY Database searches A and B were conducted using PubMed and ScienceDirect. In search A, studies on berberine's antidementia activities were identified using "berberine" and "dementia" as search terms. In search B, recent studies on berberine's effects on diabetes were surveyed using "berberine" and "diabetes" as search terms. INCLUSION CRITERIA Clinical and preclinical studies that investigated berberine's effects associated with MetS and cognitive dysfunction were included. DATA EXTRACTION AND ANALYSIS Data from studies were extracted by one author, and checked by a second; quality assessments were performed independently by two authors. RESULTS In search A, 61 articles were identified, and 22 original research articles were selected. In search B, 458 articles were identified, of which 101 were deemed relevant and selected. Three duplicates were removed, and a total of 120 articles were reviewed for this study. The results demonstrate that berberine exerts beneficial effects directly in the brain: enhancing cholinergic neurotransmission, improving cerebral blood flow, protecting neurons from inflammation, limiting hyperphosphorylation of tau and facilitating β-amyloid peptide clearance. In addition, evidence is growing that berberine is effective against diabetes and associated disorders, such as atherosclerosis, cardiomyopathy, hypertension, hepatic steatosis, diabetic nephropathy, gut dysbiosis, retinopathy and neuropathy, suggesting indirect benefits for the prevention of dementia. CONCLUSION Berberine could impede the development of dementia via multiple mechanisms: preventing brain damages and enhancing cognition directly in the brain, and indirectly through alleviating risk factors such as metabolic dysfunction, and cardiovascular, kidney and liver diseases. This study provided evidence to support the value of berberine in the prevention of dementia associated with MetS.
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Affiliation(s)
- Noriko Shinjyo
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8670, Japan.
| | - James Parkinson
- Department of Life Sciences, Faculty of Science and Technology at the University of Westminster, London W1W 6UW, United Kingdom
| | - Jimmy Bell
- Department of Life Sciences, Faculty of Science and Technology at the University of Westminster, London W1W 6UW, United Kingdom.
| | - Tatsuro Katsuno
- Kashiwanoha Clinic of East Asian Medicine, Chiba University Hospital, Kashiwa, Chiba 277-0882, Japan
| | - Annie Bligh
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O, NT 999077, Hong Kong, China.
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86
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Park BS, Kim SE, Lee HJ, Kim YW, Kim IH, Park JH, Park SH, Lee YJ, Seo SA, Park KM. Alterations in Structural and Functional Connectivities in Patients with End-Stage Renal Disease. J Clin Neurol 2020; 16:390-400. [PMID: 32657059 PMCID: PMC7354985 DOI: 10.3988/jcn.2020.16.3.390] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose The aim of this study was to evaluate the structural and functional connectivities of brain network using graph theoretical analysis in neurologically asymptomatic patients with end-stage renal disease (ESRD). We further investigated the prevalence of cognitive impairment (CI) in ESRD patients and analyzed the association between network measures of brain connectivity and cognitive function. Methods We prospectively enrolled 40 neurologically asymptomatic ESRD patients, 40 healthy controls, and 20 disease controls. All of the subjects underwent diffusion-tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). We calculated measures of structural and functional connectivities based on DTI and rs-fMRI, respectively, and investigated differences therein between the ESRD patients and the healthy controls. We assessed cognitive function in the ESRD patients using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery. Results The ESRD patients exhibited decreased global structural and functional brain connectivities, as well as alterations of network hubs compared to the healthy controls and disease controls. About 70% of the ESRD patients had CI. Moreover, ESRD patients without CI exhibited decreased global connectivity and alterations of network hubs. Furthermore, there was a significant positive association between measures of brain connectivity and cognitive function. Conclusions We found that ESRD patients exhibited decreased structural and functional brain connectivities, and that there was a significant association between brain connectivity and cognitive function. These alterations in the brain network may contribute to the pathophysiological mechanism of CI in ESRD patients.
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Affiliation(s)
- Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Il Hwan Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Hyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sol A Seo
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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87
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Yadla M, Reddy B. Assessment of cognitive impairment and its correlation with vitamin D levels patients on maintenance hemodialysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:431-439. [DOI: 10.4103/1319-2442.284018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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88
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Lin YT, Wu PH, Liang SS, Mubanga M, Yang YH, Hsu YL, Kuo MC, Hwang SJ, Kuo PL. Protein-bound uremic toxins are associated with cognitive function among patients undergoing maintenance hemodialysis. Sci Rep 2019; 9:20388. [PMID: 31892730 PMCID: PMC6938492 DOI: 10.1038/s41598-019-57004-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
Patients with chronic kidney disease have a greater risk of cognitive impairment. Cerebral uremic solute accumulation causes uremic encephalopathy; however, the association of protein-bound uremic toxins on cognitive function remains unclear. The present study aimed to investigate the association of two protein-bound uremic toxins, namely indoxyl sulfate (IS) and p-cresyl sulfate (PCS), on cognitive function in patients receiving hemodialysis (HD) for at least 90 days. Circulating free form IS and PCS were quantified by liquid chromatography/mass spectrometry. Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI) were used to evaluate cognitive function. In total, 260 HD patients were recruited with a mean age of 58.1 ± 11.3 years, of which, 53.8% were men, 40% had diabetes, and 75.4% had hypertension. The analysis revealed that both free IS and free PCS were negatively associated with the CASI score and MMSE. After controlling for confounders, circulating free IS levels persisted to be negatively associated with MMSE scores [β = −0.62, 95% confidence interval (CI): −1.16 to −0.08] and CASI scores (β = −1.97, 95% CI: −3.78 to −0.16), mainly in the CASI domains of long-term memory, mental manipulation, language ability, and spatial construction. However, there was no correlation between free PCS and total MMSE or total CASI scores after controlling for confounders. In conclusion, circulating free form IS, but not PCS is associated with lower cognitive function test scores in HD patients. Thus, a further study is needed to evaluate whether a decrease in free IS levels can slow down cognitive decline in HD patients.
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Affiliation(s)
- Yi-Ting Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Shin Liang
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mwenya Mubanga
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ling Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Institute of Population Sciences, National Health Research Institutes, Miaoli, Taiwan.
| | - Po-Lin Kuo
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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89
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Shi Y, Tong C, Zhang M, Gao X. Altered functional connectivity density in the brains of hemodialysis end-stage renal disease patients: An in vivo resting-state functional MRI study. PLoS One 2019; 14:e0227123. [PMID: 31891646 PMCID: PMC6938298 DOI: 10.1371/journal.pone.0227123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/12/2019] [Indexed: 01/25/2023] Open
Abstract
Background End-stage renal disease (ESRD) patients usually suffer from a high prevalence of central nervous system abnormalities, including cognitive impairment and emotional disorders, which severely influence their quality of life. There have been many neuroimaging research developments in ESRD patients with brain function abnormalities; however, the dysfunction of the salience network (SN) of them has received little attention. The purpose of this study was to investigate the changes of global functional connectivity density (gFCD) in brains of ESRD patients undergoing hemodialysis using resting-state functional magnetic resonance imaging (re-fMRI). Methods re-fMRI data were collected from 30 ESRD patients undergoing hemodialysis (14 men, 38.33±7.44 years old) and 30 matched healthy controls (13 men, 39.17±5.7 years old). Neuropsychological tests including the Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory (BDI) were used to evaluate the neurocognitive and psychiatric conditions of the subjects. Blood biochemistry tests, including hemoglobin level, serum albumin level, blood urea level, serum phosphate, serum calcium, and parathyroid hormone level, and dialysis-related indicators, including blood pressure fluctuations in dialysis, single-pool Kt/V(spKt/V), and ultrafiltration volume of dialysis were obtained from the ESRD patients. A two-sample t-test was used to examine the group differences in gFCD between ESRD patients and healthy controls after controlling for age, gender and education. Results Compared with healthy controls, ESRD patients exhibited a significantly increased gFCD in the salience network, including the bilateral insula, and dorsal anterior cingulated cortex (dACC), and there was no significant correlation between gFCD and the structural mean grey matter volume in patients for every cluster in the brain regions showing significant different gFCD between the two groups. Furthermore, there were significant negative correlations between the degree of connectivity in the right insula and spKt/V. Conclusion Our findings revealed abnormal intrinsic dysconnectivity pattern of salience network-related regions in ESRD patients from the whole brain network perspective. The negative correlation between the right insula and spKt/V suggested that increased fractional removal of urea may reduce the pathological activity in the insula.
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Affiliation(s)
- Yan Shi
- Department of Nephrology, The Ninth People’s Hospital of Chongqing, Chongqing, China
| | - Chaoyang Tong
- Department of Medical Imaging, The Ninth People’s Hospital of Chongqing, Chongqing, China
| | - Minghao Zhang
- Center for Lab Teaching and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoling Gao
- Department of Nephrology, The Ninth People’s Hospital of Chongqing, Chongqing, China
- * E-mail:
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90
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Angermann S, Schier J, Baumann M, Steubl D, Hauser C, Lorenz G, Günthner R, Braunisch MC, Kemmner S, Satanovskij R, Haller B, Heemann U, Lehnert T, Bieber R, Pachmann M, Braun J, Scherf J, Schätzle G, Fischereder M, Grimmer T, Schmaderer C. Cognitive Impairment is Associated with Mortality in Hemodialysis Patients. J Alzheimers Dis 2019; 66:1529-1537. [PMID: 30412499 DOI: 10.3233/jad-180767] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of cognitive impairment in hemodialysis patients is notably high. In previous studises performed in the general population, cognitive impairment has been associated with increased mortality. OBJECTIVE We evaluated the relationship between global cognitive function tested by a short screening instrument and mortality in hemodialysis patients. METHODS Cognitive testing was performed in 242 maintenance hemodialysis patients under standardized conditions at baseline using the Montreal Cognitive Assessment (MoCA).Cognitive impairment was defined as a MoCA test score ≤24 points, as published previously. All-cause mortality was monitored during a median follow-up of 3.54 years. Kaplan-Meier plot and Cox regression model adjusted for known risk factors for mortality in hemodialysis patients were used to examine a possible association between global cognitive function and all-cause mortality. RESULTS A MoCA test score ≤24 points resulted in a significant almost 3-fold higher hazard for all-cause mortality (unadjusted hazard ratio [HR]: 2.812; 95% confidence interval [95% CI]: 1.683-4.698; p < 0.001). After adjustment, this association was attenuated but remained significant (adjusted HR: 1.749; 95% CI: 1.007-3.038; p = 0.047). CONCLUSION Impairment of global cognitive function measured by a short screening instrument was identified for the first time as an independent predictor of all-cause mortality in hemodialysis patients. Thus, implementing the MoCA test in clinical routine could contribute to a better risk stratification of this patient population.
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Affiliation(s)
- Susanne Angermann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Schier
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marcus Baumann
- Department of Nephrology, Klinikum Ansbach, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nuremberg, Germany
| | - Dominik Steubl
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Hauser
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias C Braunisch
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Robin Satanovskij
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | | | | | - Julia Scherf
- KfH-Nierenzentrum München-Giesing, Munich, Germany
| | | | - Michael Fischereder
- Department of Nephrology, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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91
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Liu YR, Tang ZS, Duan JA, Chen L, Sun J, Zhou R, Song ZX, Shi XB, Zhu HY. ER-depletion lowering the 'hypothalamus-uterus-kidney' axis functions by perturbing the renal ERβ/Ptgds signalling pathway. Aging (Albany NY) 2019; 11:9500-9529. [PMID: 31708494 PMCID: PMC6874469 DOI: 10.18632/aging.102401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/26/2019] [Indexed: 12/14/2022]
Abstract
Researchers have long assumed that systematic estrogen fading might contribute to the sustained progression of menopausal degenerate syndromes, although definitive evidence has not been presented. Whether such findings represent a causal contribution or are the result of opportunistic messengers sent from the reproductive system to the brain is also a vital question. We constructed a multiscale network of the ovariectomy (OVX) induced estrogen receptors depletion (ER-depletion) model and integrated targeted proteomic, targeted lipidomic, cytochemical, and histopathological data across three tissues from the ovariectomy rodent model. We found that compared to control rats, OVX rats showed increased renal and uterine prostaglandin D2 synthase (Ptgds) expression and decreased hypothalamic Ptgds expression, abnormal Ptgds metabolites, the degenerate renal function profiles and decreased cognitive ability (learning and memory) in Morris water maze test. Importantly, we observed a regulatory relationship among ER (particularly ERβ), the degree of the pathological phenotype, learning behavior test and the ‘hypothalamus-uterus-kidney (HUK) axis functions. Collectively, this study elucidates that ER depletion promoted HUK aging is mostly attributed to a renal ERβ/Ptgds signalling imbalance.
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Affiliation(s)
- Yan-Ru Liu
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Zhi-Shu Tang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Jin-Ao Duan
- Key Laboratory for High Technology Research of TCM Formulae and Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Nanjing University of Chinese Medicine, Nanjing 210023, P.R. China
| | - Lin Chen
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Jing Sun
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Rui Zhou
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Zhong-Xing Song
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Xin-Bo Shi
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
| | - Hui-Yuan Zhu
- Shaanxi University of Chinese Medicine, Xianyang 712083, P.R. China
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92
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Sugisawa H, Shinoda T, Shimizu Y, Kumagai T, Sugisaki H, Sugihara Y. Caregiving for Older Adults Requiring Hemodialysis: A Comparison Study. Ther Apher Dial 2019; 24:423-430. [PMID: 31693297 DOI: 10.1111/1744-9987.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
This study examined differences in caregiving appraisal between primary family caregivers of disabled older adults receiving hemodialysis (PFCGs-wHD) and disabled older adults not receiving dialysis (PFCGs-woD). A total of 242 PFCGs-wHD and 335 PFCGs-woD were included in the analyses. We used adjustment by propensity score to control for bias by confounding factors. Caregiving appraisal was measured in terms of role strain, emotional exhaustion, and caregiving satisfaction. On the first task, PFCGs-wHD demonstrated significantly worse levels on all three appraisal indicators than did PFCGs-woD. On the second task, only higher emotional exhaustion was significantly mediated by higher role strain in PFCGs-wHD. Further, PFCGs-wHD status directly influenced lower caregiving satisfaction without mediation by higher role strain. Caregiving for disabled older adults receiving HD may be associated with significant challenges for caregivers.
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Affiliation(s)
- Hidehiro Sugisawa
- Graduate School of Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Toshio Shinoda
- Faculty of Health and Medical Science, Tsukuba International University, Ibaraki, Japan
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Tokyo, Japan
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93
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Damanik J, Mayza A, Rachman A, Sauriasari R, Kristanti M, Agustina PS, Angianto AR, Prawiroharjo P, Yunir E. Association between serum homocysteine level and cognitive function in middle-aged type 2 diabetes mellitus patients. PLoS One 2019; 14:e0224611. [PMID: 31693691 PMCID: PMC6834332 DOI: 10.1371/journal.pone.0224611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/17/2019] [Indexed: 01/16/2023] Open
Abstract
Type-2 diabetes mellitus (T2DM) is strongly associated with various complications, including cognitive impairment. Diabetic complication is related with structural and functional changes of brain. Studies investigated that homocysteine as an independent risk factor of several organ complications. This marker might have a role in pathogenesis of cognitive impairment in T2DM patients. We aimed to know the association between serum homocysteine level and cognitive impairment in middle-aged T2DM populations. The study was a cross-sectional study involving 97 T2DM patients aged <60 years old. Cognitive assessment was based on validated Indonesian version of Montreal Cognitive Assessment (MoCA-INA) test. Besides, serum homocysteine level (Hcy) was measured based on standard laboratory assay. Filling out the questionnaire of MoCA-INA was conducted when patients came to take the blood sample. This study used independent t-test, chi-square and multivariate logistic regression model to analyze the data. There were 47 subjects (48.5%) with mild cognitive impairment (MCI). Delayed recall was the most impaired domain (94.8%). There was no significant mean difference of serum Hcy level in MCI and non-MCI group (11.99±3.27 μmol/L vs 12.36±4.07 μmol/L respectively, p = 0.62). Final model of logistic regression showed no association between serum Hcy and cognitive function after adjusting confounding variables (OR: 1.778; 95%CI: 0.69-4.54). Further investigation involving slight elderly T2DM patients with larger sample size should be conducted to confirm this finding.
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Affiliation(s)
- Johanda Damanik
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Andre Mayza
- Department of Neurology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Andhika Rachman
- Department of Internal Medicine, Division of Haematology and Medical Oncology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Rani Sauriasari
- Faculty of Pharmacy, Universitas Indonesia, Jakarta, Indonesia
| | - Melly Kristanti
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Alexander Randy Angianto
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Pukovisa Prawiroharjo
- Department of Neurology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Em Yunir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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94
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Wang YF, Zheng LJ, Liu Y, Ye YB, Luo S, Lu GM, Gong D, Zhang LJ. The gut microbiota-inflammation-brain axis in end-stage renal disease: perspectives from default mode network. Am J Cancer Res 2019; 9:8171-8181. [PMID: 31754388 PMCID: PMC6857049 DOI: 10.7150/thno.35387] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022] Open
Abstract
The gut-brain axis in end-stage renal disease (ESRD) is attracting more and more attention. However, the mechanism of gut-brain axis based cognitive disorders in ESRD patients remains unclear. The purpose of this study was to investigate the linkages between the gut microbiota, inflammatory cytokines, brain default mode network (DMN) and cognitive function in ESRD patients. Methods: This prospective study enrolled 28 ESRD patients (13 males and 15 females, mean age of 44 ± 14 years) and 19 healthy controls (HCs) (12 males and 7 females, mean age of 44 ± 10 years). All subjects underwent stool microbiota analysis, blood inflammatory cytokines examination, brain MRI scans and cognitive assessments. Resting state functional MRI (rs-fMRI) data were used to construct DMN and graph theory was applied to characterize network topological properties. Two samples t-test was applied for the comparisons between ESRD and HCs. Correlation analysis and mediation analysis were conducted among factors with significant group differences. Results: ESRD patients displayed gut microbiota alterations, increased systemic inflammation and worse cognitive performance compared to HCs (all p < 0.05). Graph analysis revealed disrupted DMN topological organization, aberrant nodal centralities and functional connectivities (FCs) in ESRD patients relative to HCs (all p < 0.05, FDR corrected). Significant correlations were found between gut microbiota, inflammatory cytokines, DMN network measures and cognitive assessments. Mediation analysis found that gut microbiota alteration impaired DMN connectivity by increasing systemic inflammation. Conclusion: The present study first revealed gut microbiota alterations, systemic inflammation, DMN dissociation and cognitive dysfunction in ESRD patients simultaneously and further illuminated their inner relationship.
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95
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Chelluboina B, Vemuganti R. Chronic kidney disease in the pathogenesis of acute ischemic stroke. J Cereb Blood Flow Metab 2019; 39:1893-1905. [PMID: 31366298 PMCID: PMC6775591 DOI: 10.1177/0271678x19866733] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease has a graded and independent inverse impact on cerebrovascular health. Both thrombotic and hemorrhagic complications are highly prevalent in chronic kidney disease patients. Growing evidence suggests that in chronic kidney disease patients, ischemic strokes are more common than hemorrhagic strokes. Chronic kidney disease is asymptomatic until an advanced stage, but mild to moderate chronic kidney disease incites various pathogenic mechanisms such as inflammation, oxidative stress, neurohormonal imbalance, formation of uremic toxins and vascular calcification which damage the endothelium and blood vessels. Cognitive dysfunction, dementia, transient infarcts, and white matter lesions are widespread in mild to moderate chronic kidney disease patients. Uremic toxins produced after chronic kidney disease can pass through the blood-brain barrier and mediate cognitive dysfunction and neurodegeneration. Furthermore, chronic kidney disease precipitates vascular risk factors that can lead to atherosclerosis, hypertension, atrial fibrillation, and diabetes. Chronic kidney disease also exacerbates stroke pathogenesis, worsens recovery outcomes, and limits the eligibility of stroke patients to receive available stroke therapeutics. This review highlights the mechanisms involved in the advancement of chronic kidney disease and its possible association with stroke.
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Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Veterans Administration Hospital, Madison, WI, USA
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96
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van Zwieten A, Wong G, Ruospo M, Palmer SC, Teixeira-Pinto A, Barulli MR, Iurillo A, Saglimbene V, Natale P, Gargano L, Murgo M, Loy CT, Tortelli R, Craig JC, Johnson DW, Tonelli M, Hegbrant J, Wollheim C, Logroscino G, Strippoli GF, Cagnazzo A, Antinoro R, Sambati M, Donatelli C, Dambrosio N, Saturno C, Marangelli A, Pedone F, Matera G, Benevento M, Papagni S, Alicino F, Latassa G, Molino A, Grippaldi F, Bertino D, Montalto G, Messina S, Campo S, Nasisi P, Failla A, Bua A, Pagano S, Marino G, Sanfilippo N, Rallo D, Maniscalco A, Capostagno C, Randazzo G, Fici M, Lupo A, Fichera R, D'angelo A, Di Toro Mammarella R, Meconizzi M, Boccia E, Mantuano M, Flammini A, Moscardelli L. Associations of Cognitive Function and Education Level With All-Cause Mortality in Adults on Hemodialysis: Findings From the COGNITIVE-HD Study. Am J Kidney Dis 2019; 74:452-462. [DOI: 10.1053/j.ajkd.2019.03.424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/08/2019] [Indexed: 12/24/2022]
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97
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Nathoo B, Stroz M, Stroz P. A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient. Ann Intern Med 2019; 171:386. [PMID: 31476220 DOI: 10.7326/l19-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bharat Nathoo
- Mackenzie Health, Richmond Hill, Ontario, Canada (B.N.)
| | | | - Peter Stroz
- Mackenzie Health, Toronto, Ontario, Canada (M.S., P.S.)
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98
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Nie XD, Wang Q, Zhang YH, Xiong ZY, Liao JL, Hao L, Liu GL, Duan LP, Zheng ZX, Ren YP, Dong J. Depression at Baseline is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Perit Dial Int 2019; 39:465-471. [PMID: 31501292 DOI: 10.3747/pdi.2018.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients. Methods This multicenter prospective cohort study included 458 PD patients who were followed up for 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, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale. Results During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill. Conclusion Depression was a significant risk factor for worsening of CI in PD patients.
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Affiliation(s)
- Xue-dan Nie
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yu-hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zu-ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jin-lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-ling Liu
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Li-ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | | | - Ye-ping Ren
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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99
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Ng YH, Al Mawed S, Pankratz VS, Argyropoulos C, Singh P, Shaffi SK, Myaskovsky L, Unruh M, Harford A. Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait-listing. Clin Transplant 2019; 33:e13674. [PMID: 31332845 DOI: 10.1111/ctr.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 02/04/2023]
Abstract
The association between cognitive function and the likelihood of kidney transplant (KT) wait-listing, especially in minority populations, has not been clearly delineated. We performed a retrospective review of our pre-KT patients, who consist mainly of Hispanics and Native Americans, over a 16-month period. We collected data on baseline demographics and the Montreal Cognitive Assessment (MoCA) score, at the initial KT evaluation. We defined cognitive impairment as MoCA scores of <24. We constructed linear regression models to identify associations between baseline characteristics with MoCA scores and used Cox proportional hazards models to assess associations between MoCA score and KT wait-listing. During the study period, 154 patients completed the MoCA during their initial evaluation. Mean (standard deviation) MoCA scores were 23.9 (4.6), with 58 (38%) participants scoring <24. Advanced age, lower education and being on dialysis were associated with lower MoCA scores. For every one-point increase in MoCA, the likelihood of being wait-listed increased 1.10-fold (95% CI 1.01-1.19, P = .022). Being Native American and having kidney disease due to diabetes or hypertension were associated with longer time to wait-listing. Cognitive impairment was common in our pre-KT patients and was associated with a lower likelihood of KT wait-listing.
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Affiliation(s)
- Yue-Harn Ng
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Saleem Al Mawed
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Vernon Shane Pankratz
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Pooja Singh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Saeed Kamran Shaffi
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Larissa Myaskovsky
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Antonia Harford
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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100
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Watad A, Bragazzi NL, Tiosano S, Yavne Y, Comaneshter D, Cohen AD, Amital H. Alzheimer's Disease in Systemic Sclerosis Patients: A Nationwide Population-Based Cohort Study. J Alzheimers Dis 2019; 65:117-124. [PMID: 30040736 DOI: 10.3233/jad-180516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neurological features are often overlooked in systemic sclerosis (SSc) patients and little is known about the link between dementia and SSc. OBJECTIVES We sought to investigate whether an association exists between Alzheimer's disease (AD) and SSc, as well as assess the impact of a dual diagnosis on mortality rates, by performing an extensive data analysis on a large subject sample. METHODS We utilized the medical database of the Clalit-Health-Services in a case-control study. Patients with SSc were compared with age- and sex-matched controls with regard to the prevalence of AD and its impact on their mortality. RESULTS Our study included 2,431 SSc patients and 12,377 age- and sex-matched controls. The mean age of the study population was 63.32±18.06 years and the female to male ratio was 4.5:1. 134 (5.5%) cases had AD as a co-morbidity in comparison with 749 (5.9%) of the controls. The mortality rate was 12.5% among controls and 26.2% among SSc cases. On the Cox multivariate survival analysis, diagnosis of SSc and AD demonstrated significant HRs (2.35 (95% CI 2.05-2.69, p < 0.0001) and 2.19 (95% CI 1.94-2.48, p < 0.0001), respectively). SSc patients with AD had a relative risk of death of 2.35 (95% CI: 1.44-3.83) in comparison with SSc patients without AD. CONCLUSION AD is a predictor of death in SSc and therefore preemptive screening may be warranted. Further studies are needed to evaluate whether improvements in the medical regimen for SSc may lead to a reduction in AD development and possibly to increased survival as well.
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Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Nicola L Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Shmuel Tiosano
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yarden Yavne
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Doron Comaneshter
- Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.,The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
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