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Soliva MS, Carrascosa López C, Rico Salvador I, Ramón RO, Coca JV, Maset RG, Testal AG. The effectiveness of live music in reducing anxiety and depression among patients undergoing haemodialysis. A randomised controlled pilot study. PLoS One 2024; 19:e0307661. [PMID: 39186740 PMCID: PMC11346941 DOI: 10.1371/journal.pone.0307661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/04/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Anxiety and depression are highly prevalent disorders among individuals undergoing chronic haemodialysis. For patients with kidney disease, the haemodialysis process often exacerbates these conditions. This study aims to investigate the effects of listening to live classical music on anxiety and depression scales during haemodialysis sessions. METHODS A randomised clinical trial was conducted with a group of patients who listened to live classical music during haemodialysis sessions, while the control group received treatment as usual. Anxiety and depression levels were assessed at baseline and after 4 weeks of listening to live music. The study comprised 90 patients. RESULTS The results demonstrated a significant decrease in anxiety and depression among the intervention group, who listened to music, compared to the control group, who did not receive this intervention. Specifically, the intervention group, presented a decrease in score on the anxiety scale of -5.35 (p < 0.001) points on average and a decrease in score on the depression scale of -5.88 (p < 0.001) points on average, while in the control group the levels worsened with the progression of time. CONCLUSION It is concluded that listening to live classical music during haemodialysis sessions reduces anxiety and depression levels in HD patients. This conclusion adds value to listening to live music in the hospital context, specifically in this case, in haemodialysis rooms.
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Affiliation(s)
- Miriam Serrano Soliva
- Universitat Politècnica de València, Valencia, Spain, Conservatorio Profesional de Música de Buñol, Valencia, Spain
| | | | | | - Rafael Ortiz Ramón
- Data Analytics Department at the Hospital de Manises, Valencia, Spain, Universidad Internacional de Valencia–VIU, Valencia, Spain
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Yuan Y, Chang J, Sun Q. Research Progress on Cognitive Frailty in Older Adults with Chronic Kidney Disease. Kidney Blood Press Res 2024; 49:302-309. [PMID: 38663363 DOI: 10.1159/000538689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND As the medical challenges posed by the ageing population become increasingly severe, the proportion of older people among patients with chronic kidney disease (CKD) is increasing every year. SUMMARY The prevalence of frailty in patients with CKD is significantly higher than that in the general population, and older patients are also a high-risk group for frailty and cognitive impairment. Cognitive frailty, as an important subtype of frailty, is a syndrome characterised by cognitive dysfunction caused by physiological factors, excluding Alzheimer's disease and other types of dementia. It is characterised by the coexistence of physical frailty and cognitive impairment. Previous studies have mainly focused on cognitive impairment, and there is limited research on cognitive frailty, particularly in older patients with CKD. KEY MESSAGES This article provides a comprehensive review of the concept, epidemiology, screening methods, prevention, and treatment measures and possible pathogenesis of cognitive frailty in patients with CKD.
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Affiliation(s)
- Yuqing Yuan
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qianmei Sun
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Xue Y, Wang L, Liu T, Zhao T, Xie K, Guo J, Chen J, Tang H, Tang M. Omega-3 polyunsaturated fatty acids supplementation improves memory in first-diagnosed, drug-naïve patients with depression: Secondary analysis of data from a randomized controlled trial. J Affect Disord 2024; 350:403-410. [PMID: 38244783 DOI: 10.1016/j.jad.2024.01.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Cognitive impairments are found in most patients with major depressive disorder (MDD). It is believed that low Omega-3 polyunsaturated fatty acids (n-3 PUFAs) level raise the risk of anxiety, depressive symptoms and cognition dysfunction. Since our previous research has found n-3 PUFAs supplementation improves anxiety in MDD, this study was to further explore the effectiveness on cognitive impairment among depressed patients. METHODS A total of 72 venlafaxine treated outpatients with first-diagnosed, drug-naïve depression were enrolled. Daily n-3 PUFAs supplementation (2.4 g/d of fish oil, including 1440 mg eicosapentaenoic acid and 960 mg of docosahexaenoic acid) or placebo was used for 12 weeks. Cognitive function, measure by repeatable battery for the assessment of neuropsychological status ([RBANS]) scores, was compared over time. RESULTS Immediate memory, delayed memory and RBANS total scores were significant higher in both groups at week 4 and week 12 compared with baseline. Both groups exhibited improvement on attention scores at week 12. No significant differences were observed comparing n-3 PUFAs with placebo groups in the improvement of total RBANS scores and other subscales except in the change of immediate memory at both week 4 and week 12 (p < 0.05). LIMITATIONS Sample size was relatively low. Moreover, multiple ethnic populations and the income of patients should be considered. Lastly, we used raw scores instead of the standardized scores of RBANS. CONCLUSION N-3 PUFAs supplementation yielded a small but statistically significant improvement on immediate memory in first-diagnosed, drug-naïve depressed patients. While, antidepressant treatment resulted in significant improvement of cognitive function.
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Affiliation(s)
- Ying Xue
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Lu Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders and Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ting Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Tingyu Zhao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Kaiqiang Xie
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Jimin Guo
- College of Materials Sciences and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
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Chu WM, Tsai HB, Chen YC, Hung KY, Cheng SY, Lin CP. Palliative Care for Adult Patients Undergoing Hemodialysis in Asia: Challenges and Opportunities. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2024; 27:1-10. [PMID: 38449832 PMCID: PMC10911979 DOI: 10.14475/jhpc.2024.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/03/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.
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Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post‐Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hung-Bin Tsai
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Yu Hung
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
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Schwarz A, Hernandez L, Arefin S, Sartirana E, Witasp A, Wernerson A, Stenvinkel P, Kublickiene K. Sweet, bloody consumption - what we eat and how it affects vascular ageing, the BBB and kidney health in CKD. Gut Microbes 2024; 16:2341449. [PMID: 38686499 PMCID: PMC11062370 DOI: 10.1080/19490976.2024.2341449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
In today's industrialized society food consumption has changed immensely toward heightened red meat intake and use of artificial sweeteners instead of grains and vegetables or sugar, respectively. These dietary changes affect public health in general through an increased incidence of metabolic diseases like diabetes and obesity, with a further elevated risk for cardiorenal complications. Research shows that high red meat intake and artificial sweeteners ingestion can alter the microbial composition and further intestinal wall barrier permeability allowing increased transmission of uremic toxins like p-cresyl sulfate, indoxyl sulfate, trimethylamine n-oxide and phenylacetylglutamine into the blood stream causing an array of pathophysiological effects especially as a strain on the kidneys, since they are responsible for clearing out the toxins. In this review, we address how the burden of the Western diet affects the gut microbiome in altering the microbial composition and increasing the gut permeability for uremic toxins and the detrimental effects thereof on early vascular aging, the kidney per se and the blood-brain barrier, in addition to the potential implications for dietary changes/interventions to preserve the health issues related to chronic diseases in future.
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Affiliation(s)
- Angelina Schwarz
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leah Hernandez
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Samsul Arefin
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Sartirana
- Department of Translational Medicine, Nephrology and Kidney Transplantation Unit, University of Piemonte Orientale, Novara, Italy
| | - Anna Witasp
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
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Bossola M, Pepe G, Antocicco E, Illuminati C, Di Stasio E. Geriatric Depression Scale predicts mortality in elderly patients on chronic hemodialysis. Ther Apher Dial 2023; 27:1088-1094. [PMID: 37439003 DOI: 10.1111/1744-9987.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION The aim of this study was to determine if the Geriatric Depression Scale (GDS) was predictor of mortality in elderly patients on chronic hemodialysis (HD). METHODS A total of 140 HD patients ≥65 years were studied. Symptoms of depression were assessed through GDS and cognitive function through the Mini Mental State Examination (MMSE). GDS scores 0-9 are considered normal (Group 1); scores of 10-20 (Group 2) and 21-30 (Group 3) indicate mild and severe depression. RESULTS Median GDS was 13 (11-15): 54 patients in Group 1, 49 in Group 2, and 37 in Group 3. After a follow-up of 58.85 ± 38.8 months, 94 patients died and 46 were alive. Kaplan-Meier survival was significantly lower in patients of Groups 2 and 3 than in Group 1 (log-rank χ2 : 101.9; DF: 2; p < 0.0001). According to Cox regression analysis, mortality was associated with age and GDS, and inversely associated with MMSE and Kt/V. CONCLUSION GDS predicts mortality in elderly HD patients.
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Rome, Italy
| | - Gilda Pepe
- Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Rome, Italy
| | - Emanuela Antocicco
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Illuminati
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Di Stasio
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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Mehrotra R, Davison SN, Farrington K, Flythe JE, Foo M, Madero M, Morton RL, Tsukamoto Y, Unruh ML, Cheung M, Jadoul M, Winkelmayer WC, Brown EA. Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2023; 104:441-454. [PMID: 37290600 DOI: 10.1016/j.kint.2023.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has been related primarily to numerical targets for laboratory measures, and outcomes such as cardiovascular disease and mortality. Routine symptom assessment is not universal or standardized in dialysis care. Even when symptoms are identified, treatment options are limited and are initiated infrequently, in part because of a paucity of evidence in the dialysis population and the complexities of medication interactions in kidney failure. In May of 2022, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference-Symptom-Based Complications in Dialysis-to identify the optimal means for diagnosing and managing symptom-based complications in patients undergoing maintenance dialysis. Participants included patients, physicians, behavioral therapists, nurses, pharmacists, and clinical researchers. They outlined foundational principles and consensus points related to identifying and addressing symptoms experienced by patients undergoing dialysis and described gaps in the knowledge base and priorities for research. Healthcare delivery and education systems have a responsibility to provide individualized symptom assessment and management. Nephrology teams should take the lead in symptom management, although this does not necessarily mean taking ownership of all aspects of care. Even when options for clinical response are limited, clinicians should focus on acknowledging, prioritizing, and managing symptoms that are most important to individual patients. A recognized factor in the initiation and implementation of improvements in symptom assessment and management is that they will be based on locally existing needs and resources.
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Affiliation(s)
- Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jennifer E Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marjorie Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Magdalena Madero
- Department of Medicine, Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yusuke Tsukamoto
- Department of Nephrology, Itabashi Medical System (IMS) Itabashi Chuo Medical Center, Tokyo, Japan
| | - Mark L Unruh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
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Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: What do we need to know? Heliyon 2023; 9:e19383. [PMID: 37662812 PMCID: PMC10472011 DOI: 10.1016/j.heliyon.2023.e19383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Chronic kidney disease (CKD) is now recognized as a major public health problem in the world. The global prevalence of CKD is estimated at 13.4% (11.7-15.1%), with an estimated 490.2 to 7.083 million patients with End stage renal disease requiring renal replacement therapy. Hemodialysis is the main treatment for End stage renal disease patients because of its high safety and efficiency. The survival time of these patients was significantly prolonged, but many psychological problems followed. Depression is a type of mood disorder caused by a variety of causes, often manifested as disproportionate depression and loss of interest, sometimes accompanied by anxiety, agitation, even hallucinations, delusions and other psychotic symptoms. Depression has become the most common mental disorder in maintenance hemodialysis (MHD) patients according to the meta-analysis. In recent years, depression has seriously affected the quality of life and prognosis of MHD patients from dietary, sleep, treatment adherence, energy and other dimensions. This article reviews the epidemiology, etiology, diagnosis and treatment of depression in MHD patients.
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Affiliation(s)
- Yulu Li
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianqin Shen
- Blood Purification Centre, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Giannakou K, Golenia A, Liabeuf S, Malyszko J, Mattace-Raso F, Farinha A, Spasovski G, Hafez G, Wiecek A, Capolongo G, Capasso G, Massy ZA, Pépin M. Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease. Front Med (Lausanne) 2023; 10:1215583. [PMID: 37621458 PMCID: PMC10446481 DOI: 10.3389/fmed.2023.1215583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies' limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.
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Affiliation(s)
- Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Francesco Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ana Farinha
- Department of Nephrology, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Goce Spasovski
- University Department of Nephrology, Clinical Centre “Mother Theresa”University Sts Cyril and Methodius, Skopje, North Macedonia
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Türkiye
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Ziad A. Massy
- Service de Néphrologie, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris & Université Paris-Saclay (Versailles-Saint-Quentin-en-Yvelines), Boulogne Billancourt, France
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Marion Pépin
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Departement of Geriatric Medicine, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
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Choi HS, Kim B, Han KD, Oh TR, Suh SH, Kim M, Kim CS, Bae EH, Ma SK, Kim SW. Weight change and risk of depression in patients with diabetic kidney disease: a nationwide population-based study. Kidney Res Clin Pract 2023; 42:86-97. [PMID: 36328992 PMCID: PMC9902731 DOI: 10.23876/j.krcp.21.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/10/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Several studies have reported that depression is prevalent in patients with diabetes or chronic kidney disease. However, the relationship between weight changes and the risk of depression has not been elucidated in patients with diabetic kidney disease (DKD). METHODS From the Korean National Health Insurance Service database, we selected 67,866 patients with DKD and body weight data from two consecutive health examinations with a 2-year interval between 2009 and 2012. Weight change over 2 years was categorized into five groups: ≥-10%, <-10% to ≥-5%, <-5% to <5%, ≥5% to <10%, and ≥10%. The occurrence of depression was monitored via the codes of International Statistical Classification of Diseases, 10th revision through the end of 2018. RESULTS During the 5.24-year follow-up, 17,023 patients with DKD developed depression. Weight change and the risk of depression had a U-shaped relationship: patients with ≥-10% weight change (hazard ratio [HR], 1.12) and those with ≥10% weight change (HR, 1.11) showed higher HRs for depression than those with <-5% to <5% weight change, even after adjusting for several confounding factors. In the subgroup analyses, the risk of depression tended to increase as weight gain or weight loss increased in all subgroups. CONCLUSION Both weight loss and weight gain increased the risk of depression in patients with DKD.
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Affiliation(s)
- Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Minah Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea,Correspondence: Soo Wan Kim Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea. E-mail:
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11
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Zheng J, Wu X, Dai J, Pan C, Shi H, Liu T, Jiao Z. Aberrant brain gray matter and functional networks topology in end stage renal disease patients undergoing maintenance hemodialysis with cognitive impairment. Front Neurosci 2022; 16:967760. [PMID: 36033631 PMCID: PMC9399762 DOI: 10.3389/fnins.2022.967760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To characterize the topological properties of gray matter (GM) and functional networks in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis to provide insights into the underlying mechanisms of cognitive impairment. Materials and methods In total, 45 patients and 37 healthy controls were prospectively enrolled in this study. All subjects completed resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion kurtosis imaging (DKI) examinations and a Montreal cognitive assessment scale (MoCA) test. Differences in the properties of GM and functional networks were analyzed, and the relationship between brain properties and MoCA scores was assessed. Cognitive function was predicted based on functional networks by applying the least squares support vector regression machine (LSSVRM) and the whale optimization algorithm (WOA). Results We observed disrupted topological organizations of both functional and GM networks in ESRD patients, as indicated by significantly decreased global measures. Specifically, ESRD patients had impaired nodal efficiency and degree centrality, predominantly within the default mode network, limbic system, frontal lobe, temporal lobe, and occipital lobe. Interestingly, the involved regions were distributed laterally. Furthermore, the MoCA scores significantly correlated with decreased standardized clustering coefficient (γ), standardized characteristic path length (λ), and nodal efficiency of the right insula and the right superior temporal gyrus. Finally, optimized LSSVRM could predict the cognitive scores of ESRD patients with great accuracy. Conclusion Disruption of brain networks may account for the progression of cognitive dysfunction in ESRD patients. Implementation of prediction models based on neuroimaging metrics may provide more objective information to promote early diagnosis and intervention.
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Affiliation(s)
- Jiahui Zheng
- Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Xiangxiang Wu
- Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Jiankun Dai
- GE Healthcare, MR Research China, Beijing, China
| | - Changjie Pan
- Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- *Correspondence: Haifeng Shi,
| | - Tongqiang Liu
- Department of Nephrology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Tongqiang Liu,
| | - Zhuqing Jiao
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou, China
- Zhuqing Jiao,
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12
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Neuropsychological Assessment of Cognitive Impairment in Kidney Transplantation (NAsKiT) and its related risk factors: a study protocol. J Nephrol 2022; 35:1933-1941. [PMID: 35763254 PMCID: PMC9458686 DOI: 10.1007/s40620-022-01376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/02/2022] [Indexed: 10/27/2022]
Abstract
BACKGROUND Association of cognitive impairment with chronic kidney disease has been reported over the last decade. Individuals show better cognitive performance after kidney transplantation than individuals on dialysis but are more likely to be affected by cognitive impairment than age-matched comparison groups. Better knowledge of the prevalence as well as course and profile of cognitive impairment is important for the design of future studies assessing the clinical impact of cognitive impairment and developing management strategies. The goal of our study is to examine the extent of cognitive impairment before and after transplantation and to derive a distinct profile of cognitive function using standard neurocognitive tests. Furthermore, we aim to assess whether transplantation per se leads to an improvement in cognitive performance. METHODS We are conducting a prospective single-center cohort study involving 100 kidney transplant individuals. Individuals who are wait-listed to receive a kidney transplantation or have already received one will be included in this study. Individuals will undergo a battery of detailed neurocognitive tests at baseline (in part before surgery), and then 3 and 12 months afterwards. Furthermore, the enrolled patients will complete a validated German version of the Cognitive Failure Questionnaire for self-assessment (s-CFQ) as well as the Hospital Anxiety and Depression Scale -Deutsche (HADS-D), a self-report screening instrument with two scales that capture anxiety and depression. In addition, a hair sample will be taken at each measurement time point for the determination of hair cortisol levels as a parameter for the cumulative hypothalamic-pituitary-adrenocortical axis activity over the previous three months. The primary outcome measure will be (a) the effect of kidney transplantation on the cognitive performance up to 12 months after transplantation and (b) the course of cognitive performance following kidney transplantation over time. DISCUSSION The results of our study have potentially important implications for the prevention and treatment of cognitive impairment in kidney transplant individuals. By increasing our knowledge of the neurocognitive profile and assigning the corresponding deficits, it might be possible to create an individualized training program to positively impact cognitive deficits in kidney transplant patients.
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13
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Liu T, Deng K, Xue Y, Yang R, Yang R, Gong Z, Tang M. Carnitine and Depression. Front Nutr 2022; 9:853058. [PMID: 35369081 PMCID: PMC8964433 DOI: 10.3389/fnut.2022.853058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Depression has become one of the most common mental diseases in the world, but the understanding of its pathogenesis, diagnosis and treatments remains insufficient. Carnitine is a natural substance that exists in organisms, which can be synthesized in vivo or supplemented by intake. Relationships of carnitine with depression, bipolar disorder and other mental diseases have been reported in different studies. Several studies show that the level of acylcarnitines (ACs) changes significantly in patients with depression compared with healthy controls while the supplementation of acetyl-L-carnitine is beneficial to the treatment of depression. In this review, we aimed to clarify the effects of ACs in depressive patients and to explore whether ACs might be the biomarkers for the diagnosis of depression and provide new ideas to treat depression.
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Affiliation(s)
- Ting Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
| | - Kunhong Deng
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ying Xue
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
| | - Rui Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
| | - Rong Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
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14
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Schorr M, Zalitach M, House C, Gomes J, Wild CJ, Salerno FR, McIntyre C. Cognitive Impairment Early After Initiating Maintenance Hemodialysis: A Cross Sectional Study. Front Neurol 2022; 13:719208. [PMID: 35370903 PMCID: PMC8964944 DOI: 10.3389/fneur.2022.719208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Abnormalities in cognitive function are almost universal in patients receiving hemodialysis (HD) and are associated with worse quality of life, impaired decision making, increased healthcare utilization and mortality. While cognitive impairment in the HD population is increasingly recognized, it is unclear how quickly it develops after starting HD. Methods This was a cross-sectional study of a cohort of low dialysis vintage HD patients (<12 months). We used the validated Cambridge Brain Science (CBS) battery of web-based tests to evaluate cognition compared to age- and sex matched controls across three cognitive domains: verbal processing, reasoning and short-term memory. Results Forty-nine HD patients were included in this study; 43 completed the full battery of tests. The average scores for HD patients were consistently below the age and sex-matched controls. Fifty-five percent of HD patients had cognitive impairment in verbal skills, 43% in reasoning and 18% in short-term memory. Conclusions There is a high prevalence of CI evident early after starting HD, with the largest deficits seen in reasoning and verbal processing. These deficits may be attributable to the HD treatment itself. Further studies are needed to characterize the natural history of CI in this patient population and to test interventions aimed at preventing or slowing its progression.
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Affiliation(s)
- Melissa Schorr
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mariah Zalitach
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
| | - Cindy House
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
| | - Janice Gomes
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada.,Department of Pathology and Laboratory Medicine, University of Western Ontario, London, ON, Canada
| | - Conor J Wild
- Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Fabio R Salerno
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Christopher McIntyre
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada.,The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
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15
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Kelly DM, Rothwell PM. Disentangling the Relationship Between Chronic Kidney Disease and Cognitive Disorders. Front Neurol 2022; 13:830064. [PMID: 35280286 PMCID: PMC8914950 DOI: 10.3389/fneur.2022.830064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a rapidly rising global health burden that affects nearly 40% of older adults. Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia, and thus represent a vulnerable population. It is currently unknown to what extent this risk may be attributable to a clustering of traditional risk factors such as hypertension and diabetes mellitus leading to a high prevalence of both symptomatic and subclinical ischaemic cerebrovascular lesions, or whether other potential mechanisms, including direct neuronal injury by uraemic toxins or dialysis-specific factors could also be involved. These knowledge gaps may lead to suboptimal prevention and treatment strategies being implemented in this group. In this review, we explore the mechanisms of susceptibility and risk in the relationship between CKD and cognitive disorders.
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Affiliation(s)
- Dearbhla M. Kelly
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter M. Rothwell
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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16
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Crowe K, Quinn TJ, Mark PB, Findlay MD. "Is It Removed During Dialysis?"-Cognitive Dysfunction in Advanced Kidney Failure-A Review Article. Front Neurol 2021; 12:787370. [PMID: 34925220 PMCID: PMC8674209 DOI: 10.3389/fneur.2021.787370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Cognitive impairment is independently associated with kidney disease and increases in prevalence with declining kidney function. At the stage where kidney replacement therapy is required, with dialysis or transplantation, cognitive impairment is up to three times more common, and can present at a younger age. This is not a new phenomenon. The cognitive interactions of kidney disease are long recognized from historical accounts of uremic encephalopathy and so-called "dialysis dementia" to the more recent recognition of cognitive impairment in those undergoing kidney replacement therapy (KRT). The understanding of cognitive impairment as an extra-renal complication of kidney failure and effect of its treatments is a rapidly developing area of renal medicine. Multiple proposed mechanisms contribute to this burden. Advanced vascular aging, significant multi-morbidity, mood disorders, and sleep dysregulation are common in addition to the disease-specific effects of uremic toxins, chronic inflammation, and the effect of dialysis itself. The impact of cognitive impairment on people living with kidney disease is vast ranging from increased hospitalization and mortality to decreased quality of life and altered decision making. Assessment of cognition in patients attending for renal care could have benefits. However, in the context of a busy clinical service, a pragmatic approach to assessing cognitive function is necessary and requires consideration of the purpose of testing and resources available. Limited evidence exists to support treatments to mitigate the degree of cognitive impairment observed, but promising interventions include physical or cognitive exercise, alteration to the dialysis treatment and kidney transplantation. In this review we present the history of cognitive impairment in those with kidney failure, and the current understanding of the mechanisms, effects, and implications of impaired cognition. We provide a practical approach to clinical assessment and discuss evidence-supported treatments and future directions in this ever-expanding area which is pivotal to our patients' quality and quantity of life.
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Affiliation(s)
- Kirsty Crowe
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Patrick B. Mark
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mark D. Findlay
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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17
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Chu NM, Hong J, Harasemiw O, Chen X, Fowler KJ, Dasgupta I, Bohm C, Segev DL, McAdams-DeMarco MA. Chronic kidney disease, physical activity, and cognitive function in older adults- results from the National Health and Nutrition Examination Survey (2011-2014). Nephrol Dial Transplant 2021; 37:2180-2189. [PMID: 34850174 DOI: 10.1093/ndt/gfab338] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive impairment is common among persons with chronic kidney disease (CKD) due in part to reduced kidney function. Given that physical activity (PA) is known to mitigate cognitive decline, we examined whether associations between CKD stage and global/domain-specific cognitive function differs by PA. METHODS We leveraged 3,223 participants (aged≥60years) enrolled in National Health and Nutrition Examination Survey (NHANES,2011-2014), with at least one measure of objective cognitive function (immediate recall [CERAD-WL], delayed recall [CERAD-DR], verbal fluency [AF], executive function/processing speed [DSST], global [average of 4 tests]) or self-perceived memory decline [SCD]. We quantified the association between CKD stage (no CKD: eGFR≥60 mL/min/1.73m2 and albuminuria(ACR)<30 mg/g; stage G1-G3: eGFR≥60mL/min/1.73m2 and ACR≥30mg/g or eGFR 30-59mL/min/1.73m2; stage G4-G5: eGFR<30mL/min/1.73m2) and cognitive function using linear regression (objective measures) and logistic regression (SCD), accounting for sampling weights for nationally-representative estimates. We tested whether associations differed by physical activity (Global Physical Activity Questionnaire, high PA≥600MET*min/week vs. low PA<600MET*min/week) using a Wald test. RESULTS Among NHANES participants, 34.9% had CKD stageG1-G3, 2.6% had stageG4-G5, and 50.7% had low PA. CKD stageG4-G5 was associated with lower global cognitive function (difference = -0.38SD, 95%CI:-0.62,-0.15). This association differed by PA (pinteraction = 0.01). Specifically, among participants with low PA, those with CKD stageG4-G5 had lower global cognitive function (difference = -0.57SD, 95%CI: -0.82,-0.31) compared to those without CKD. Among those with high PA, no difference was found (difference = 0.10SD, 95%CI:-0.29,0.49). Similarly, CKD stage was only associated with immediate recall, verbal fluency, executive function, and processing speed among those with low PA; no associations were observed for delayed recall or self-perceived memory decline. CONCLUSIONS CKD is associated with lower objective cognitive function among those with low, but not high PA. Clinicians should consider screening older patients with CKD who have low PA for cognitive impairment and encourage them to meet PA guidelines.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jingyao Hong
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oksana Harasemiw
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin J Fowler
- Principal, The Voice of the Patient, Inc. Chicago, Illinois, USA
| | - Indranil Dasgupta
- University of Warwick, Heartlands Hospital Birmingham and Warwick Medical School, West Midlands, England, UK
| | - Clara Bohm
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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18
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Feng J, Lu X, Wang S, Li H. The assessment of cognitive impairment in maintenance hemodialysis patients and the relationship between cognitive impairment and depressive symptoms. Semin Dial 2021; 35:504-510. [PMID: 34726291 DOI: 10.1111/sdi.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cognitive impairment and depression are common mental health problems in chronic kidney disease (CKD) patients with maintenance hemodialysis (MHD). Previous studies have proven that cognitive impairment and depression were risk factors for poor prognosis in MHD patients. However, the related factors of cognitive function and the association between cognitive impairment and depression in MHD patients are still unclear. The purpose of this study is to explore the related factors affecting the cognitive function of MHD patients and evaluate the relationship between cognitive function and depression in MHD patients. METHODS This single-center, cross-sectional study enrolled 160 MHD patients. Cognitive function and depressive symptoms were measured using Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. RESULTS Cognitive impairment was detected in 58.1% of 160 MHD patients. Multivariate linear regression analysis showed that age, level of education and homocysteine (HCY) were independent influencing factors of MoCA scores and the scores of attention and abstract thinking were independently correlated with PHQ-9 score after adjusting for confounding factors CONCLUSIONS: These findings indicated that age, level of education and HCY were independently associated with cognitive function, and attention and abstract thinking could independently affect depressive symptoms in MHD patients.
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Affiliation(s)
- Jianan Feng
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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19
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Pépin M, Ferreira AC, Arici M, Bachman M, Barbieri M, Bumblyte IA, Carriazo S, Delgado P, Garneata L, Giannakou K, Godefroy O, Grodzicki T, Klimkowicz-Mrowiec A, Kurganaite J, Liabeuf S, Mocanu CA, Paolisso G, Spasovski G, Vazelov ES, Viggiano D, Zoccali C, Massy ZA, Więcek A. Cognitive disorders in patients with chronic kidney disease: specificities of clinical assessment. Nephrol Dial Transplant 2021; 37:ii23-ii32. [PMID: 34718757 PMCID: PMC8713156 DOI: 10.1093/ndt/gfab262] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Indexed: 12/20/2022] Open
Abstract
Neurocognitive disorders are frequent among chronic kidney disease (CKD) patients. Identifying and characterizing cognitive impairment (CI) can help to assess the ability of adherence to CKD risk reduction strategy, identify potentially reversible causes of cognitive decline, modify pharmacotherapy, educate the patient and caregiver and provide appropriate patient and caregiver support. Numerous factors are associated with the development and progression of CI in CKD patients and various conditions can influence the results of cognitive assessment in these patients. Here we review clinical warning signs that should lead to cognitive screening; conditions frequent in CKD at risk to interfere with cognitive testing or performance, including specificities of cognitive assessment in dialysis patients or after kidney transplantation; and available tests for screening and observed cognitive patterns in CKD patients.
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Affiliation(s)
| | - Ana Carina Ferreira
- Department of Nephrology, Centro Hospitalar e Universitário de Lisboa Central–Hospital Curry Cabral, Lisbon, Portugal
- Department of Nephology, Universidade Nova de Lisboa–Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Mustafa Arici
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Hacetepe University, Ankara, Turkey
| | - Maie Bachman
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Inga Arune Bumblyte
- Department of Nephrology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sol Carriazo
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Pilar Delgado
- Department of Neurology, Vall d’Hebron Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Liliana Garneata
- Department of Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, “Dr Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | | | - Justina Kurganaite
- Department of Nephrology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sophie Liabeuf
- Department of Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Carmen Antonia Mocanu
- Department of Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, “Dr Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Goce Spasovski
- Department of Nephrology, Clinical Centre “Mother Theresa”, Saints Cyril and Methodius University, Skopje, North Macedonia
| | | | - Davide Viggiano
- Department of Nephrology, University of Campania “Luigi Vanvitelli”, Naples; BIOGEM, Ariano Irpino, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, NY, USA
- Associazione Ipertensione Nefrologia Trapianto Renale, Reggio Calabria, Italy
| | - Ziad A Massy
- Paris-Saclay University, UVSQ, Inserm, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Villejuif, France
- Department of Nephrology, Ambroise Paré University Medical Center, APHP, Paris, France
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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20
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Assessment of cognitive impairment and related risk factors in hemodialysis patients. J Nephrol 2021; 35:931-942. [PMID: 34655416 PMCID: PMC8995241 DOI: 10.1007/s40620-021-01170-3] [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: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022]
Abstract
Background Cognitive impairment in hemodialysis patients has been acknowledged over the last years and has been reported in up to 80% of patients. Older age, high prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients. Methods We conducted a prospective cohort study on 408 patients from 10 hemodialysis centers in the regional government district of Middle Hesse (Germany). Patients underwent a neuropsychological test battery consisting of five tests, in addition to a phonemic fluency test, to assess cognitive profile. The patients were classified as no cognitive impairment or mildly-, moderately- or severely-impaired cognitive function, depending on the degree of impairment and number of domains where the deficit was determined. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cognitive status at baseline vs. 1-year follow-up. Results Of 479 eligible patients, 408 completed all tests at baseline. Only 25% (n = 102) of the patients had no cognitive impairment. Fourteen per cent (n = 57), 36.5% (n = 149), and 24.5% (n = 100) of patients showed mild, moderate, and severe impairment, respectively. In patients with cognitive impairment, all cognitive domains were affected, and impairment was significantly associated with depression and education. The most impaired cognitive performance was immediate memory recall, and the best performance was found in naming ability. No significant change was observed after 1-year follow up in any domain. Conclusion Our study shows that the prevalence of cognitive impairment in hemodialysis patients is high and that it is affected by the presence of depression. Furthermore, education has an effect on cognitive test results. As depression has a significant influence on cognitive impairment, its early identification is essential in order to initiate treatment at an early stage, hoping to positively influence cognitive performance. Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01170-3.
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21
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Chronic Kidney Disease and Cognitive Impairment. J Stroke Cerebrovasc Dis 2021; 30:105529. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
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Ameri N, Nobahar M, Ghorbani R, Bazghalee M, Sotodeh-Asl N, Babamohamadi H. Effect of reminiscence on cognitive impairment and depression in haemodialysis patients. J Ren Care 2021; 47:208-216. [PMID: 33423401 DOI: 10.1111/jorc.12359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment and depression are common problems in haemodialysis patients. AIM The present study was carried out to determine the impact of reminiscence on cognitive impairment and depression in haemodialysis patients. DESIGN This clinical trial (2016) was conducted with a pretest-posttest design on the haemodialysis patients of hospitals in Shahrud, Iran. PARTICIPANTS AND MEASUREMENTS Block random sampling was used to investigate the patients' cognitive status and Beck's Depression Scale were administered among 75 patients divided into intervention (given 12 sessions of Stinson's group reminiscence), control (group discussions), and sham (without any intervention) groups before, immediately and 30 days after the intervention. RESULTS Immediately and 30 days after the intervention, the cognitive score was significantly higher in the reminiscence group than the control (p < 0.001) and sham (p < 0.001) groups. Immediately after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.011) and sham (p < 0.001) groups. Also, immediately and 30 days after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.031) and sham (p < 0.001) groups. CONCLUSIONS The findings showed that reminiscence increased the cognitive health score and improved depression in haemodialysis patients. Therefore, reminiscence protocols can be utilized as an independent routine nursing care measure for improving cognitive status and depression in haemodialysis patients.
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Affiliation(s)
- Neda Ameri
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Milad Bazghalee
- Department of Nursing, Faculty of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nemath Sotodeh-Asl
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study. PLoS One 2021; 16:e0252237. [PMID: 34033657 PMCID: PMC8148363 DOI: 10.1371/journal.pone.0252237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. Methods We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression ≥ 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of <1-year and >1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. Results At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage <1-year compared to >1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Conclusion Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.
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24
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Posselt J, Harbeck B, Rahvar AH, Kropp P, Haas CS. Improved cognitive function after kidney transplantation compared to hemodialysis. Ther Apher Dial 2021; 25:931-938. [PMID: 33497026 DOI: 10.1111/1744-9987.13625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/04/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
End-stage renal disease is associated with chronic stress that in turn may result in endocrine changes, affect cognitive, and physical capacities and increase the risk for cardiovascular events. The objective of this study was to evaluate and characterize possible stress parameters and compare cognitive function in those patients. Physiological and biochemical stress parameters as well as cognitive function were assessed in 17 hemodialysis and 18 renal transplant patients and both groups were compared. Serum cortisol and interleukin-6 levels were elevated in both groups but showed no significant difference. Cholesterol and low-density lipoprotein levels were significantly higher in patients following renal transplantation. While heart rate variability was comparable in both groups, most cognitive tests showed better results in renal transplant patients. We showed that: (1) cognitive function may improve following renal transplantation; (2) standard biochemical stress parameters are not useful to discriminate stress in patients with chronic kidney disease; and (3) heart rate variability is unaltered in this setting.
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Affiliation(s)
- Jana Posselt
- Department of Medicine, University of Luebeck, Hamburg, Germany
| | - Birgit Harbeck
- Department of Medicine, University of Luebeck, Hamburg, Germany.,Amedes Experts Hamburg, Hamburg, Germany
| | - Amir-Hossein Rahvar
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University of Rostock, Rostock, Germany
| | - Christian Stefan Haas
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, University of Marburg, Marburg, Germany
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25
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Buoli M, Caldiroli L, Guenzani D, Carnevali GS, Cesari M, Turolo S, Barkin JL, Messa P, Agostoni C, Vettoretti S. Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons With Nondialysis Chronic Kidney Disease. J Ren Nutr 2020; 31:537-540. [PMID: 33386204 DOI: 10.1053/j.jrn.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/22/2020] [Accepted: 08/30/2020] [Indexed: 11/11/2022] Open
Abstract
Depressive symptoms worsen the outcomes of patients affected by chronic kidney disease (CKD). The purpose of the present article is to study the association between serum lipid profile and the severity of depression in patients with CKD. We evaluated 132 older subjects with advanced CKD (stage 3-5, not receiving dialysis) in regular follow-up in a nephrology clinic. Blood samples were collected after an overnight fast. All patients were evaluated with the Geriatric Depression Scale which is comprised of 30 items that assess the severity of depressive symptoms. A backward multivariate regression analysis was performed to study the association between lipid profile and severity of depression. Low-density lipoprotein levels (β = 2.77, P = .008) and arachidonic acid/linoleic acid ratio (β = 2.51, P = .015) were found to be significantly associated with severity of depressive symptoms. Change in dietary habits or the use of hypocholesterolemic drugs could potentially prevent depressive symptoms and ameliorate outcome of patients affected by CKD. Data from prospective studies are needed to confirm these preliminary results.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Lara Caldiroli
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dalila Guenzani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Turolo
- Pediatric Department of Nephrology Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Piergiorgio Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Chien CW, Lin YC, Huang SK, Chen PE, Tung TH. A population-based study of the association between hemodialysis and cognitive impairment. Asia Pac Psychiatry 2020; 12:e12404. [PMID: 32715665 DOI: 10.1111/appy.12404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION End-stage renal disease is a serious public health issue. The objective of this retrospective cohort study was to assess the association between hemodialysis and cognitive impairment, while controlling for age, sex, residence, and comorbidities. METHODS This study assesses the risk of cognitive impairment among a nationwide cohort of new hemodialysis patients derived from the NHIRD. RESULTS A total of 4330 patients were assigned to the dialysis group and 17 320 patients were assigned to the control group. A total of 2103 of the patients developed cognitive impairment within 2 years after the date of dialysis initiation. Patients who developed cognitive impairment were older (69.85 ± 11.56) than their counterparts who did not develop cognitive impairment (58.58 ± 14.77; P < .001). The log-rank test of Kaplan-Meier analysis revealed a higher risk of cognitive impairment in the hemodialysis group than in the non-hemodialysis group (P < .001). The interval between dialysis initiation and the onset of cognitive impairment was 98.66 ± 46.39 months among non-dialysis subjects and 53.45 ± 41.90 months among dialysis subjects, and the between-group difference was significant (P < .001). The Cox Proportional Hazard Model revealed that after controlling for gender, age, residence, and comorbidities, hemodialysis was shown to have a significant impact on cognitive impairment (Hazard Ratio [HR]: 1.44; 95% confidence interval [CI]: 1.29-1.60). Furthermore, the risk of developing cognitive impairment increased with age (HR: 1.07; 95% CI: 1.06-1.08). DISCUSSION Hemodialysis was associated with cognitive impairment. There was a significant association between age and cognitive impairment, regardless of the comorbidities prior to hemodialysis. There was no evidence of an association between comorbidities and cognitive impairment after beginning hemodialysis.
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Affiliation(s)
- Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Ying Chi Lin
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Song-Kong Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Pei-En Chen
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan, China
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan, China.,Maoming People's Hospital, Maoming, Guangdong, China
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Daniel SC, Azuero A, Gutierrez OM, Heaton K. Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients. Qual Life Res 2020; 30:759-768. [PMID: 33108580 DOI: 10.1007/s11136-020-02684-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Lifestyle changes associated with end-stage renal disease may be a factor in depression and quality of life (QOL) for patients receiving hemodialysis. This cross-sectional study examined the relationship between nutritional status, QOL, and depression in 124 hemodialysis patients. METHODS Nutritional markers included serum albumin, normalized protein catabolic rate (nPCR), body mass index (BMI), body fat percentage, and daily protein intake. Physical and Mental dimension scores of the Kidney Disease QOL-Short Form (KDQOL-SF), and the Center for Epidemiological Studies of Depression (CESD) survey were used to measure QOL and depression, respectively. Data were analyzed using regression analyses. Measures of effect size were used for interpretation. RESULTS Nutritional status indicators explained a moderate amount of the variability of the Physical dimension of QOL (crude R2 = .14, covariate-adjusted ΔR2 = .06) but had weak explanatory ability for the Mental dimension of QOL (crude R2 = .05, covariate-adjusted ΔR2 = .02) and CESD (crude R2 = .02, covariate-adjusted ΔR2 = .005). Additional findings suggested the presence of non-linear relationships between protein intake and both the Physical and Mental QOL dimension scores. Longer dialysis vintage was also correlated with lower psychosocial patient outcomes. CONCLUSION While nutritional status is an important element in predicting hemodialysis patient outcomes, its relationship to depression and QOL, in this sample, demonstrated only moderate explanatory ability. However, dialysis vintage and level of education had a significant relationship with depression and QOL. These findings suggest that patients with longer dialysis vintage and limited health literacy require unique plans of care. Future studies aimed at understanding the interrelationships between non-modifiable patient characteristics and psychosocial outcomes are imperative.
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Affiliation(s)
- Shawona C Daniel
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA.
| | - Andres Azuero
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA
| | | | - Karen Heaton
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA
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28
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Stanciu GD, Ababei DC, Bild V, Bild W, Paduraru L, Gutu MM, Tamba BI. Renal Contributions in the Pathophysiology and Neuropathological Substrates Shared by Chronic Kidney Disease and Alzheimer's Disease. Brain Sci 2020; 10:E563. [PMID: 32824404 PMCID: PMC7464898 DOI: 10.3390/brainsci10080563] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease and Alzheimer's disease are chronic conditions highly prevalent in elderly communities and societies, and a diagnosis of them is devastating and life changing. Demanding therapies and changes, such as non-compliance, cognitive impairment, and non-cognitive anomalies, may lead to supplementary symptoms and subsequent worsening of well-being and quality of life, impacting the socio-economic status of both patient and family. In recent decades, additional hypotheses have attempted to clarify the connection between these two diseases, multifactorial in their nature, but even so, the mechanisms behind this link are still elusive. In this paper, we sought to highlight the current understanding of the mechanisms for cognitive decline in patients with these concurrent pathologies and provide insight into the relationship between markers related to these disease entities and whether the potential biomarkers for renal function may be used for the diagnosis of Alzheimer's disease. Exploring detailed knowledge of etiologies, heterogeneity of risk factors, and neuropathological processes associated with these conditions opens opportunities for the development of new therapies and biomarkers to delay or slow their progression and validation of whether the setting of chronic kidney disease could be a potential determinant for cognitive damage in Alzheimer's disease.
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Affiliation(s)
- Gabriela Dumitrita Stanciu
- Center for Advanced Research and Development in Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania; (G.D.S.); (B.-I.T.)
| | - Daniela Carmen Ababei
- Pharmacodynamics and Clinical Pharmacy Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Veronica Bild
- Pharmacodynamics and Clinical Pharmacy Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Walther Bild
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Luminita Paduraru
- Department Mother & Child Care, Division Neonatology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania
| | - Mihai Marius Gutu
- Department of Biophysics and Medical Physics-Nuclear Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Bogdan-Ionel Tamba
- Center for Advanced Research and Development in Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania; (G.D.S.); (B.-I.T.)
- Department of Pharmacology, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania
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29
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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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30
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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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Zhou H, Al-Ali F, Kang GE, Hamad AI, Ibrahim RA, Talal TK, Najafi B. Application of Wearables to Facilitate Virtually Supervised Intradialytic Exercise for Reducing Depression Symptoms. SENSORS 2020; 20:s20061571. [PMID: 32178231 PMCID: PMC7146558 DOI: 10.3390/s20061571] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022]
Abstract
Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing intradialytic exercise program (exergame). The intradialytic exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptoms compared to nurse-supervised intradialytic exercise in 73 hemodialysis patients (age = 64.5 ± 8.7years, BMI = 31.6 ± 7.6kg/m2). Participants were randomized into an exergame group (EG) or a supervised exercise group (SG). Both groups received similar exercise tasks for 4 weeks, with three 30 min sessions per week, during hemodialysis treatment. Depression symptoms were assessed at baseline and the fourth week using the Center for Epidemiologic Studies Depression Scale. Both groups showed a significant reduction in depression score (37%, p < 0.001, Cohen's effect size d = 0.69 in EG vs. 41%, p < 0.001, d = 0.65 in SG) with no between-group difference for the observed effect (p > 0.050). The EG expressed a positive intradialytic exercise experience including fun, safety, and helpfulness of sensor feedback. Together, results suggested that the virtually supervised low-intensity intradialytic exergame is feasible during routine hemodialysis treatment. It also appears to be as effective as nurse-supervised intradialytic exercise to reduce depression symptoms, while reducing the burden of administrating exercise on dialysis clinics.
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Affiliation(s)
- He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (H.Z.); (G.E.K.)
| | - Fadwa Al-Ali
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar; (F.A.-A.)
| | - Gu Eon Kang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (H.Z.); (G.E.K.)
| | - Abdullah I. Hamad
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar; (F.A.-A.)
| | - Rania A. Ibrahim
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar; (F.A.-A.)
| | - Talal K. Talal
- Diabetic Foot and Wound Clinic, Hamad Medical Corporation, PO Box 3050, Doha, Qatar;
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (H.Z.); (G.E.K.)
- Correspondence: or ; Tel.: +1-713-798-7536
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32
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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: 40] [Impact Index Per Article: 10.0] [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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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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Abstract
This article covers current research on the relationship between depression and cognitive impairment in older adults. First, it approaches the clinical assessment of late-life depression and comorbid cognitive impairment. Cognitive risk factors for suicide are discussed. Research is then provided on neuropsychological changes associated with depression, discussing subjective cognitive impairment, mild cognitive impairment, and dementia profiles. In addition, literature regarding neuroimaging and biomarker findings in depressed older adults is presented. Finally, therapeutic models for treatment of late-life depression are discussed, including psychotherapy models, holistic treatments, pharmacologic approaches, and brain stimulation therapies.
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Affiliation(s)
- Ryan D Greene
- Department of Psychology in Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA; University of Indianapolis, Indianapolis, IN, USA.
| | - Alex Cook
- University of Indianapolis, Indianapolis, IN, USA
| | - Dustin Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sophia Wang
- Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN, USA
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Cognitive Impairment and its Correlates in Chronic Kidney Disease Patients Undergoing Haemodialysis. ACTA ACUST UNITED AC 2019; 8:2818-2822. [PMID: 31632935 DOI: 10.14260/jemds/2019/611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Cognitive Impairment (CI) has been found to be quite common amongst patients with Chronic Kidney Disease (CKD) undergoing haemodialysis (HD). The presence of these deficits could affect patient's adherence to diet regimens, treatment and also reduce their Quality of Life. The presence of depression in such patients can further lead to CI. We wanted to assess the prevalence of CI in CKD patients undergoing haemodialysis, socio-demographic and patient related variables affecting CI, and also the relationship between depression and cognition. METHODS Fifty patients undergoing haemodialysis from two dialysis units were assessed. The Montreal Cognitive Assessment (MoCA) scale and Patient Health Questionnaire-9 (PHQ-9) were administered to patients. Descriptive analysis was done for the socio-demographic and clinical variables. Chi square test was used to find the association between the categorical data. Kruskal-Wallis test was used to determine the association between categorical and quantitative variables. RESULTS Mean age of patient was 50.32 (±12.4) years. Mean duration of dialysis was 18.8 (±15.11) months. The prevalence of depression in the patients was 42%. Cognitive impairment was present in 44% of the patients. There was a significant relationship between education level and recall (χ2=31.7, df=12, p=.002) as well as orientation (χ2=29.78, df=8, p=.000) domains of cognition. Also, there was a significant relationship between socio-economic status and global cognition score (χ2=81.13, df=48, p=.002). There was a negative correlation between duration of dialysis and cognition. Significant relationships were found between depression and various cognitive domains. CONCLUSIONS The prevalence of CI in haemodialysis patients is high. It is also affected by factors such as education level, socio-economic status, duration of dialysis and presence of depression. Insight into CI is essential for its early identification during the course of illness, so that patient precise treatment decisions can be made.
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Guenzani D, Buoli M, Caldiroli L, Carnevali GS, Serati M, Vezza C, Armelloni S, Messa P, Vettoretti S. Malnutrition and inflammation are associated with severity of depressive and cognitive symptoms of old patients affected by chronic kidney disease. J Psychosom Res 2019; 124:109783. [PMID: 31443824 DOI: 10.1016/j.jpsychores.2019.109783] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Chronic kidney disease (CKD) is a disabling condition associated with different medical comorbidities including depression and cognitive impairment. We investigated the association between malnutrition, inflammation and depressive/cognitive symptoms in elderly subjects with advanced CKD. METHODS We evaluated cross-sectionally 132 elderly subjects (age ≥65 years) with advanced CKD (stage 4-5, non-dialytic-ND) in regular follow up at the outpatient clinic of nephrology. Blood and urinary samples were collected after an overnight fast. All patients were evaluated by Geriatric Depression Scale (GDS)-30 items for severity of depressive symptoms, Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) for cognition. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Different linear regression models were performed to study the association between clinical variables, diet and inflammatory parameters with the above mentioned rating scale scores. A final linear regression model with only previous statistically significant variables was performed for GDS scores. RESULTS Our cohort consisted of 95 males and 37 females with a mean age of 78 ± 7. Female gender (B = 3.20, p < .01), higher MIS (B = 0.29, p = .02) and higher IL-12p70 serum levels (pg/mL) (B = 0.37, p = .03) were associated with severity of depressive symptoms. MIS was associated with the severity of cognitive impairment as assessed by MMSE (B = -0.19, p < .01) and CDT (B = 0.10, p = .03). CONCLUSION In elderly subjects affected by CKD the severity of depressive symptoms and cognitive impairment is associated with specific inflammatory and nutritional parameters. These results have to be considered as preliminary and need replication by further studies.
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Affiliation(s)
- Dalila Guenzani
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Massimiliano Buoli
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; University of Milan, Milan, Italy.
| | - Lara Caldiroli
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Greta Silvia Carnevali
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Marta Serati
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Carlotta Vezza
- University of Milan, Milan, Italy; Unit of Gerontology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Armelloni
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Kogon AJ, Kim JY, Laney N, Radcliffe J, Hooper SR, Furth SL, Hartung EA. Depression and neurocognitive dysfunction in pediatric and young adult chronic kidney disease. Pediatr Nephrol 2019; 34:1575-1582. [PMID: 31049719 DOI: 10.1007/s00467-019-04265-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Depression affects 7-35% of children with chronic kidney disease (CKD), and in adults with CKD, the presence of depression links to poorer medical outcomes, social functioning difficulties, and neurocognitive impairments. The relationship between depression and neurocognitive function in youth with CKD is unclear. We sought to identify factors associated with depression in youth with CKD and to determine whether depression affects neurocognitive performance. METHODS We conducted cross-sectional analyses in 71 CKD and 64 control participants aged 8 to 25 years who completed depression inventories and neurocognitive assessments as part of the Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with CKD Study. In the CKD group, multivariable logistic regression analysis determined associations between clinical and demographic factors and depression. In the full study cohort, multivariable linear regression analyses, including an interaction term between CKD status and depression evaluated the effect of depression on 11 neurocognitive outcome domains. RESULTS Obesity significantly associated with depression in the CKD group (OR 10.25, P = 0.01). In adjusted analyses, depressed youth with CKD scored worse than non-depressed CKD participants by 0.6-1.0 standard deviations in 5 neurocognitive domains: attention, visual memory, visual-spatial, visual working memory, and problem solving. CONCLUSIONS CKD youth with obesity are more likely to be depressed, and those who are depressed exhibit worse neurocognitive performance. Depression may represent a therapeutic target to improve neurocognitive performance in youth with CKD.
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Affiliation(s)
- Amy J Kogon
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19103, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Ji Young Kim
- Biostatistics Core, the Center for Human Phenomic Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nina Laney
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jerilynn Radcliffe
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19103, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19103, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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38
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Fan S, Lin L, Chen VC, Hsieh C, Hsiao H, McIntyre RS, Iacobucci M, Coles AS, Tsai D, Weng J, Chen Y. Effects of Lower Past‐Year Serum Sodium and Hyponatremia on Depression Symptoms and Cognitive Impairments in Patients With Hemodialysis. Ther Apher Dial 2019; 24:169-177. [DOI: 10.1111/1744-9987.13395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Szu‐Shan Fan
- Department of SurgeryPingtung Christian Hospital Pingtung Taiwan
| | - Lian‐Feng Lin
- Department of Internal MedicineChristian Hospital Pingtung Taiwan
| | - Vincent Chin‐Hung Chen
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
- School of MedicineChang Gung University Taoyuan Taiwan
| | - Chin‐Wen Hsieh
- Graduate Institute of Medicine, College of MedicineKaohsiung Medical University Kaohsiung Taiwan
- Division of Nephrology, Department of Internal MedicinePingtung Christian Hospital Pingtung Taiwan
| | - Han‐Pin Hsiao
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health NetworkUniversity of Toronto Toronto ON USA
- Department of PsychiatryUniversity of Toronto Toronto ON USA
| | - Michelle Iacobucci
- Mood Disorders Psychopharmacology Unit, University Health NetworkUniversity of Toronto Toronto ON USA
| | - Alexandria S Coles
- Mood Disorders Psychopharmacology Unit, University Health NetworkUniversity of Toronto Toronto ON USA
| | - Duu‐Jian Tsai
- Center for Bioethics and Social MedicinePingtung Christian Hospital Pingtung Taiwan
- Graduate Institute of Health & Social PolicyNational Yang‐Ming University Taipei Taiwan
| | - Jun‐Cheng Weng
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
- Department of Medical Imaging and Radiological SciencesChang Gung University Taoyuan Taiwan
| | - Yi‐Lung Chen
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
- Department of Healthcare AdministrationAsia University Taichung Taiwan
- Department of PsychologyAsia University Taichung Taiwan
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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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Drew DA, Weiner DE, Sarnak MJ. Cognitive Impairment in CKD: Pathophysiology, Management, and Prevention. Am J Kidney Dis 2019; 74:782-790. [PMID: 31378643 DOI: 10.1053/j.ajkd.2019.05.017] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/07/2019] [Indexed: 12/27/2022]
Abstract
Patients with chronic kidney disease (CKD) are at substantially higher risk for developing cognitive impairment compared with the general population, and both lower glomerular filtration rate and the presence of albuminuria are associated with the development of cognitive impairment and poorer cognitive function. Given the excess of vascular disease seen in individuals with CKD, cerebrovascular disease is likely the predominant pathology underlying these associations, though impaired clearance of uremic metabolites, depression, sleep disturbance, anemia, and polypharmacy may also contribute. Modification of vascular disease risk factors may be helpful in limiting decline, though definite data are lacking. Specific to CKD, targeting a low blood pressure and reduction in albuminuria with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may slow cognitive decline, albeit modestly. Initiation of dialysis can improve severe impairment associated with uremia but does not appear to affect more subtle chronic cognitive impairment. In contrast, kidney transplantation appears to lead to improved cognitive function in many transplant recipients, suggesting that dialysis methods do not provide the same cognitive benefits as having a functioning kidney. Management of patients with both CKD and cognitive impairment should include a comprehensive plan including more frequent follow-up visits; involvement of family in shared decision making; measures to improve compliance, such as written instruction and pill counts; and a focus on advance directives in conjunction with an emphasis on understanding an individual patient's life goals. Further research is needed on novel therapies, including innovative dialysis methods, that aim to limit the development of cognitive impairment, slow decline in those with prevalent impairment, and improve cognitive function.
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Affiliation(s)
- David A Drew
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
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Oh H, Mo J, Seo W. Correlates of cognitive impairment in patients with chronic kidney failure on haemodialysis: Systematic review and meta-analysis. J Adv Nurs 2018; 75:962-978. [PMID: 30407656 DOI: 10.1111/jan.13907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/08/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
AIM To review and identify correlates of cognitive impairment in patients with chronic kidney failure (CKF) on haemodialysis. BACKGROUND The literature is consistent with regard to the high prevalence of cognitive impairment among patients with CKF on haemodialysis and its dependence on multidimensional risk factors. DESIGN Systematic review and meta-analysis based on Cochrane Handbook and PRISMA. DATA SOURCES Electronic searches of the MEDLINE, EMBASE, Cochrane Library databases and major Korean databases were used. Only original research that assessed correlates of cognitive impairment in patients with CKF on haemodialysis and published between 2004-2016 in English or Korean were included. REVIEW METHODS Studies were selected according to the PICOS: Population (chronic kidney failure patients with cognitive impairment on haemodialysis); Intervention (not applicable); Comparison (healthy controls or patients with chronic kidney failure on haemodialysis without cognitive impairment); Outcome (cognitive impairment); and Study design (primarily nonexperimental correlational studies and studies with experimental, quasi-experimental, or pre-post cohort designs). Q-test and I2 index were used to examine study homogeneity. RESULTS A total of 39 studies were finally included. Age, gender, stroke history, difficulties in activities of daily life, haemoglobin levels, pain, sleep difficulties, and depression were found to be significant correlates of cognitive impairment. CONCLUSIONS Nurses should be aware that the risk of cognitive impairment in patients with CKF on haemodialysis can be significantly higher for elders, women and in patients with a stroke, greater difficulties in activities of daily living, lower haemoglobin concentrations, higher pain levels, sleep difficulties, or depression.
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Affiliation(s)
- HyunSoo Oh
- Department of Nursing, Inha University, Incheon, Korea
| | - JinA Mo
- National Evidence-based Health Care Collaborating Agency, Seoul, Korea
| | - WhaSook Seo
- Department of Nursing, Inha University, Incheon, Korea
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Li A, Mu J, Huang M, Zhang Z, Liu J, Zhang M. Altered amygdala-related structural covariance and resting-state functional connectivity in end-stage renal disease patients. Metab Brain Dis 2018; 33:1471-1481. [PMID: 29869149 DOI: 10.1007/s11011-018-0254-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023]
Abstract
Depression and cognitive control deficits were frequently reported in concurrent end-stage renal disease (ESRD) patients. Neuroimaging studies indicated depression could be a risk factor for cognitive control deficits, and amygdala-related circuitry may play a critical role in this abnormal interaction. To investigate the potential relationship between depressive symptoms and cognitive control reduction in ESRD patients, T1-weighted and resting fMRI images were obtained in 29 ESRD patients and 29 healthy controls. Voxel-based morphometry (VBM), structural covariance (SC) analysis based on grey matter volume (GMV), and functional connectivity (FC) analysis were adopted. All subjects performed the Beck Depression Inventory (BDI) assessment and Stroop test. The patients also underwent blood biochemistry tests (urea, creatinine, phosphate, Ca2+, hematocrit, cystatin, hemoglobin). Compared with controls, GMV reductions were found mainly in the anterior cingulate cortex (ACC) and bilateral amygdala, and decreased SC was found between the amygdala and ACC in ESRD patients. This indicated that structural changes in the amygdala may be related to the GMV alterations in the ACC. Additionally, decreased FC between the amygdala and ACC was revealed in ESRD patients. Negative correlation was found between the FC of the amygdala-ACC and reaction delay during the Stroop test, but this correlation disappeared after controlling BDI. Stepwise regression analysis showed that the low level of hemoglobin was contributed to the reduced FC of the amygdala-ACC in ESRD patients. Our results demonstrated the abnormal interaction between depressive mood and cognitive control deficits in ESRD patients.
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Affiliation(s)
- Anmao Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
- Xi'an Children's Hospital, Xi'an, 710061, People's Republic of China
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Mingxia Huang
- Xi'an Children's Hospital, Xi'an, 710061, People's Republic of China
| | - Zengjun Zhang
- Xi'an Children's Hospital, Xi'an, 710061, People's Republic of China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China.
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.
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43
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Wang YY, Zhang WW, Feng L, Gao D, Liu C, Zhong L, Ren JW, Wu YZ, Huang L, Fu LL, He YN. Development and Preliminary Validation of a Depression Assessment Tool for Maintenance Hemodialysis Patients. Ther Apher Dial 2018; 23:49-58. [PMID: 30239119 DOI: 10.1111/1744-9987.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Yun-yan Wang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Wei-wei Zhang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Lei Feng
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Dong Gao
- Department of Sleep and Psychology, Institute of Surgery Research, Daping Hospital; Third Military Medical University; Chongqing China
| | - Chun Liu
- Department of Nephrology; The Third People's Hospital of Chongqing; Chongqing China
| | - Ling Zhong
- Department of Nephrology, The Second Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - Jiang-wen Ren
- Department of Nephrology; The First People's Hospital of Jiulongpo District; Chongqing China
| | - Ya-zhou Wu
- Department of Statistics, Preventive Medicine; Third Military Medical University; Chongqing China
| | - Long Huang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Li-li Fu
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Ya-ni He
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
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Hagemann PDMS, Martin LC, Neme CMB. The effect of music therapy on hemodialysis patients' quality of life and depression symptoms. ACTA ACUST UNITED AC 2018; 41:74-82. [PMID: 30222176 PMCID: PMC6534034 DOI: 10.1590/2175-8239-jbn-2018-0023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/09/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The sources of stress involved in chronic kidney disease (CKD) can lead to depressive states, directly affecting the hemodialysis patient's quality of life (QOL). There are few reports and studies on therapeutic interventions that aim to minimize depressive symptoms in these patients and an even greater shortage of studies using music therapy. OBJECTIVE This study evaluated the effect of music therapy on QOL and depressive symptoms in hemodialysis patients. METHOD This was a music therapy intervention study in which 23 patients were evaluated regarding QOL and depression symptoms at two distinct stages - before and after the intervention. Eight sessions of music therapy were conducted, with two weekly sessions and an average duration of 75 minutes. The intervention was conducted by the music therapist herself, using specific music therapy techniques, besides voice and guitar to conduct harmonic and rhythmic support for the groups' sound-music production. RESULTS The patients showed a significant reduction in depression symptoms (p < 0.001) and better QOL results, with significant differences in the following dimensions: functional capacity (p = 0.011), pain (p = 0.036), general health (p = 0.01), vitality (p = 0.004), mental health (p = 0.012), symptom and problem list (p = 0.01), and overall health (p = 0.01). CONCLUSIONS Intervention with music therapy constitutes an effective option in the treatment and prevention of depressive symptoms and improved QOL of HD patients.
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Affiliation(s)
| | - Luis Cuadrado Martin
- Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Clínica Médica, Botucatu, SP, Brasil
| | - Carmen Maria Bueno Neme
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Ciências, Bauru, SP, Brasil.,Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Psicologia, Bauru, SP, Brasil
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He S, Zhu J, Jiang W, Ma J, Li G, He Y. Sleep disturbance, negative affect and health-related quality of life in patients with maintenance hemodialysis. PSYCHOL HEALTH MED 2018; 24:294-304. [PMID: 30160172 DOI: 10.1080/13548506.2018.1515493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The study was designed to examine the relationships between sleep disturbance, negative affect and quality of life among patients with maintenance hemodialysis. A total of 118 patients in Shanghai, China, with maintenance hemodialysis (>40 years old) participated in the study. They completed three questionnaires: the Positive and Negative Affect Scale (PANAS), the Pittsburgh Sleep Quality Index (PSQI) and the European Quality of 5-Dimensions (EQ-5D-5L). Results showed that male participants' negative affect scored significantly higher than female participants'.The mean global PSQI score was 8.64 (poor sleepers score 6 or more); sleep disturbance affected 63.6% of the patients, which indicated that in general the participants' sleep quality was relatively poor.The patients with worse sleep quality and negative affect were more likely to have a lower quality of life. In addition, the effect of the sleep disturbance on quality of life was mediated by negative affect (The Z value of Sobel test was -3.18, p< .01).These findings suggest sleep disturbance and negative affect were common among patients with maintenance hemodialysis and had a negative impact on their quality of life; negative affect may mediate the relationship between sleep disturbance and quality of life.
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Affiliation(s)
- Shanshan He
- a School of Social Development , East China Normal University , Shanghai , China
| | - Jingfen Zhu
- b School of Public Health , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Weijie Jiang
- c Department of Nephrology , Shanghai Shi Bei Hospital , Shanghai , China
| | - Jun Ma
- d Department of Nephrology , Jing An District Center Hospital of Shanghai , Shanghai , China
| | - Guohong Li
- b School of Public Health , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yaping He
- b School of Public Health , Shanghai Jiao Tong University School of Medicine , Shanghai , China.,e Center for HTA , China Hospital Development Institute, Shanghai Jiao Tong University , Shanghai , China
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Assari S, Moghani Lankarani M. Workplace Racial Composition Explains High Perceived Discrimination of High Socioeconomic Status African American Men. Brain Sci 2018; 8:E139. [PMID: 30060492 PMCID: PMC6120025 DOI: 10.3390/brainsci8080139] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sociological and epidemiological literature have both shown that socioeconomic status (SES) protects populations and individuals against health problems. Recent research, however, has shown that African Americans gain less from their SES and African Americans of high SES, particularly males, may be vulnerable to perceived discrimination, as explained by the Minorities' Diminished Returns theory. One potential mechanism for this phenomenon is that high SES African Americans have a higher tendency to work in predominantly White workplaces, which increases their perceived discrimination. It is, however, unknown if the links between SES, working in predominantly White work groups and perceived discrimination differ for male and female African Americans. AIM To test the associations between SES, workplace racial composition and perceived discrimination in a nationally representative sample of male and female African American adults. METHODS This study included a total number of 1775 employed African American adults who were either male (n = 676) or female (n = 1099), all enrolled from the National Survey of American Life (NSAL). The study measured gender, age, SES (educational attainment and household income), workplace racial composition and perceived discrimination. Structural Equation Modeling (SEM) was applied in the overall sample and also by gender. RESULTS In the pooled sample that included both genders, high education and household income were associated with working in a predominantly White work group, which was in turn associated with more perceived discrimination. We did not find gender differences in the associations between SES, workplace racial composition and perceived discrimination. CONCLUSION Although racial composition of workplace may be a mechanism by which high SES increases discriminatory experiences for African Americans, males and females may not differ in this regard. Policies are needed to reduce discrimination in racially diverse workplaces. This is particularly the case for African Americans who work in predominantly White work environments.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109-2700, USA.
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- BRITE Center for Science, Research and Policy, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
| | - Maryam Moghani Lankarani
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109-2700, USA.
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Assari S, Preiser B, Lankarani MM, Caldwell CH. Subjective Socioeconomic Status Moderates the Association between Discrimination and Depression in African American Youth. Brain Sci 2018; 8:E71. [PMID: 29677115 PMCID: PMC5924407 DOI: 10.3390/brainsci8040071] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 12/04/2022] Open
Abstract
Background: Most of the literature on the association between socioeconomic status (SES) and health is focused on the protective effects of SES. However, a growing literature suggests that high SES may also operate as a vulnerability factor. Aims: Using a national sample of African American youth, this study compared the effects of perceived discrimination on major depressive disorder (MDD) based on SES. Methods: The current cross-sectional study included 810 African American youth who participated in the National Survey of American Life-Adolescent supplement. The independent variable was perceived discrimination. Lifetime, 12-month, and 30-day MDD were the dependent variables. Age and gender were covariates. Three SES indicators (subjective SES, income, and poverty index) were moderators. We used logistic regressions for data analysis. Results: Perceived discrimination was associated with higher risk of lifetime, 12-month, and 30-day MDD. Interactions were found between subjective SES and perceived discrimination on lifetime, 12-month, and 30-day MDD, suggesting a stronger effect of perceived discrimination in youth with high subjective SES. Objective measures of SES (income and poverty index) did not interact with perceived discrimination on MDD. Conclusion: While perceived discrimination is a universally harmful risk factor for MDD, its effect may depend on the SES of the individual. Findings suggest that high subjective SES may operate as a vulnerability factor for African American youth.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Brianna Preiser
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA.
| | | | - Cleopatra H Caldwell
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
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Abstract
This article covers current research on the relationship between depression and cognitive impairment in older adults. First, it approaches the clinical assessment of late-life depression and comorbid cognitive impairment. Cognitive risk factors for suicide are discussed. Research is then provided on neuropsychological changes associated with depression, discussing subjective cognitive impairment, mild cognitive impairment, and dementia profiles. Additionally, literature regarding neuroimaging and biomarker findings in depressed older adults is presented. Finally, therapeutic models for treatment of late-life depression are also discussed, including psychotherapy models, holistic treatments, pharmacologic approaches, and brain-stimulation therapies.
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Dasgupta I, Patel M, Mohammed N, Baharani J, Subramanian T, Thomas GN, Tadros G. Cognitive Function Declines Significantly during Haemodialysis in a Majority of Patients: A Call for Further Research. Blood Purif 2018; 45:347-355. [PMID: 29455207 DOI: 10.1159/000485961] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/01/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. METHODS All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. RESULTS Eight-two patients completed both tests - median age 73 (52-91) years, 59% male, dialysis vintage 41 (3-88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. CONCLUSION Cognitive function declines over a haemodialysis session and this has significant clinical implications over health literacy, self-management and tasks like driving. More research is needed to find the cause for this decline in cognition.
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Affiliation(s)
- Indranil Dasgupta
- Department of Nephrology, Heartlands Hospital, Birmingham, United Kingdom
| | - Mitesh Patel
- Department of Psychiatry, Heartlands Hospital, Birmingham, United Kingdom
| | - Nuredin Mohammed
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jyoti Baharani
- Department of Nephrology, Heartlands Hospital, Birmingham, United Kingdom
| | | | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - George Tadros
- Department of Psychiatry, Heartlands Hospital, Birmingham, United Kingdom.,Aston Medical School, Aston University, Birmingham, United Kingdom
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Assari S, Caldwell CH. Social Determinants of Perceived Discrimination among Black Youth: Intersection of Ethnicity and Gender. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E24. [PMID: 29462893 PMCID: PMC5835993 DOI: 10.3390/children5020024] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/23/2017] [Accepted: 01/26/2018] [Indexed: 12/02/2022]
Abstract
Most of the existing sociological and epidemiological literature has focused on the protective effects of high socioeconomic status (SES) on population health through reducing exposure to risk factors and increasing human and material resources that can mitigate adversities. Recent studies, however, have documented poor mental health of high SES Blacks, particularly African American males and Caribbean Black females. The literature also shows a link between perceived discrimination and poor mental health. To better understand the extra costs of upward social mobility for minority populations, this study explored ethnic by gender variations in the associations between SES indicators and perceived discrimination in an ethnically diverse national sample of Black youth. This study included 810 African American and 360 Caribbean Black youth who were sampled in the National Survey of American Life-Adolescent supplement (NSAL-A). Three SES indicators (financial hardship, family income, and income to needs ratio) were the independent variables. The dependent variable was perceived (daily) discrimination. Age was the covariate. Ethnicity and gender were the focal moderators. Linear regressions were used for data analysis in the pooled sample and also based on the intersection of ethnicity and gender. Considerable gender by ethnicity variations were found in the patterns of the associations between SES indicators and perceived discrimination. Financial hardship was a risk factor for perceived discrimination in African American males only. High family income and income to needs ratio were associated with high (but not low) perceived discrimination in African American males and Caribbean Black females. SES indicators were not associated with perceived discrimination for African American females or Caribbean Black males. When it comes to Black youth, high SES is not always protective. Whether SES reduces or increases perceived discrimination among Black youth depends on the intersection of ethnicity by gender. Additional research is needed to understand why and how high SES increases exposure and vulnerability to discrimination for some groups of Black youth.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
| | - Cleopatra Howard Caldwell
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
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