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Di Rosa M, D’Alia S, Guarasci F, Soraci L, Pierpaoli E, Lenci F, Ricci M, Onder G, Volpato S, Ruggiero C, Cherubini A, Corsonello A, Lattanzio F. Cognitive Impairment, Chronic Kidney Disease, and 1-Year Mortality in Older Patients Discharged from Acute Care Hospital. J Clin Med 2020; 9:E2202. [PMID: 32664677 PMCID: PMC7408778 DOI: 10.3390/jcm9072202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/01/2023] Open
Abstract
The prognostic interaction between chronic kidney disease (CKD) and cognitive impairment is still to be elucidated. We investigated the potential interaction of overall cognitive impairment or defective constructional praxis and CKD in predicting 1-year mortality among 646 older patients discharged from hospital. The estimated glomerular filtration rate (eGFR) was calculated using the Berlin Initiative Study (BIS) equation. Cognitive impairment was assessed by the Mini Mental State Exam (MMSE) and defective constructional praxis was ascertained by the inherent MMSE item. The study outcome was 1-year mortality. Statistical analysis was carried out using Cox regression. After adjusting for potential confounders, the co-occurrence of eGFR <30 and overall cognitive impairment (Hazard Ratio (HR) = 3.12, 95% Confidence Interval (CI) = 1.26-7.77) and defective constructional praxis (HR = 2.50, 95% CI = 1.08-5.77) were associated with the outcome. No significant prognostic interaction of eGFR < 30 with either overall cognitive impairment (HR = 1.99, 95% CI = 0.38-10.3) or constructional apraxia (HR = 1.68, 95% CI = 0.33-8.50) was detectable, while only cognitive deficits were found significantly associated with the outcome in the interaction models (HR = 3.12, 95% CI = 1.45-6.71 for overall cognitive impairment and HR = 2.16, 95% CI = 1.05-4.45 for constructional apraxia). Overall cognitive impairment and defective constructional praxis may be associated with increased risk of 1-year mortality among older hospitalized patients with severe CKD. However, no significant prognostic interaction between CKD and cognitive impairment could be observed.
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Affiliation(s)
- Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Sonia D’Alia
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Francesco Guarasci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Luca Soraci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Elisa Pierpaoli
- Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS INRCA, 60124 Ancona, Italy;
| | - Federica Lenci
- Unit of Nephrology and Dialysis, IRCCS INRCA, 60124 Ancona, Italy; (F.L.); (M.R.)
| | - Maddalena Ricci
- Unit of Nephrology and Dialysis, IRCCS INRCA, 60124 Ancona, Italy; (F.L.); (M.R.)
| | - Graziano Onder
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, 06132 Perugia, Italy;
| | - Antonio Cherubini
- Geriatria Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60124 Ancona, Italy;
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
- Unit of Geriatric Medicine, IRCSS INRCA, 60124 Ancona, Italy
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