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Shi C, Jia S, Wang X, Liu C, Shao F, Shi Y, Li Z. Research on cognitive impairment and potential risk factors in peritoneal dialysis patients: An observational study. Medicine (Baltimore) 2024; 103:e38374. [PMID: 38996170 PMCID: PMC11245193 DOI: 10.1097/md.0000000000038374] [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: 03/25/2023] [Accepted: 05/03/2024] [Indexed: 07/14/2024] Open
Abstract
The objective of this study is to investigate the associated risk factors and their effects on cognitive impairment (CI) in patients undergoing peritoneal dialysis. A retrospective analysis was conducted on the basic information of 268 patients who underwent continuous ambulatory peritoneal dialysis (CAPD) at our hospital from January 2020 to September 2023. Cognitive function was assessed using the Montreal Cognitive Assessment Scale during their subsequent dialysis visits. Participants were categorized into a CI group and a cognitively normal group. Blood and other biological samples were collected for relevant biomarker analysis. Subsequently, we analyzed and compared the factors influencing CI between the 2 groups. The prevalence of CI among CAPD patients was 58.2%. Compared to the cognitively normal group, the CI group had a higher prevalence of alcohol consumption, lower levels of education, and reduced serum uric acid levels (P < .05). There was also a higher incidence of autoimmune diseases such as systemic lupus erythematosus in the CI group (P < .05). In terms of dialysis efficacy, the residual kidney Kt/V and residual kidney Ccr were significantly lower in the CI group compared to the cognitively normal group. In blood parameters, the CI group showed elevated total cholesterol levels and lower serum calcium concentrations (P < .05). Logistic regression analysis identified male gender, older age, lower educational attainment, hypercholesterolemia, and elevated high-sensitivity C-reactive protein levels as independent risk factors for CI in CAPD patients (P < .05). Additionally, in this patient cohort, dialysis duration and residual renal function were protective factors against CI (P < .05). CI is prevalent among PD patients. Elevated high-sensitivity C-reactive protein levels, male gender, older age, lower educational attainment, and hypercholesterolemia constitute an independent risk factor for CI in CAPD patients, whereas residual renal function acts as a protective element.
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Affiliation(s)
- Chunxia Shi
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Shujing Jia
- Department of Neurology, Beijing Shuangqiao Hospital, Beijing, China
| | - Xiaoqi Wang
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Conghui Liu
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Feng Shao
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Yanan Shi
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Zhongxin Li
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
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Zahr NM, Pfefferbaum A. Serum albumin and white matter hyperintensities. Transl Psychiatry 2024; 14:233. [PMID: 38824150 PMCID: PMC11144249 DOI: 10.1038/s41398-024-02953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024] Open
Abstract
People living with HIV and those diagnosed with alcohol use disorders (AUD) relative to healthy individuals commonly have low levels of serum albumin, substantiated as an independent predictor of cardiovascular events. White matter hyperintensities (WMH)-a neuroimaging feature of cerebral small vessel disease-are also related to cardiovascular disease. Despite consensus regarding associations between high levels of urine albumin and WMH prevalence, and low serum albumin levels and impaired cognitive functioning, relations between serum albumin and WMH burdens have rarely been evaluated. Here, a sample including 160 individuals with AUD, 142 living with HIV, and 102 healthy controls was used to test the hypothesis that serum albumin would be inversely related to WMH volumes and directly related to cognitive performance in the two diagnostic groups. Although serum albumin and periventricular WMH volumes showed an inverse relationship in both AUD and HIV groups, this relationship persisted only in the HIV group after consideration of traditional cardiovascular (i.e., age, sex, body mass index (BMI), nicotine use, hypertension, diabetes), study-relevant (i.e., race, socioeconomic status, hepatitis C virus status), and disease-specific (i.e., CD4 nadir, HIV viral load, HIV duration) factors. Further, serum albumin contributed more significantly than periventricular WMH volume to variance in performance on a verbal learning and memory composite score in the HIV group only. Relations in both HIV and AUD groups between albumin and hematological red blood cell markers (e.g., hemoglobin, hematocrit) suggest that in this sample, serum albumin reflects hematological abnormalities. Albumin, a simple serum biomarker available in most clinical settings, may therefore help identify periventricular WMH burden and performance levels in specific cognitive domains in people living with HIV. Whether serum albumin contributes mechanistically to periventricular WMH in HIV will require additional investigation.
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Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Neuroscience Program, SRI International, Menlo Park, CA, USA.
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Neuroscience Program, SRI International, Menlo Park, CA, USA
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Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol 2024; 19:641-649. [PMID: 37574658 PMCID: PMC11108252 DOI: 10.2215/cjn.0000000000000280] [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: 02/02/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.
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Affiliation(s)
- Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
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Sánchez-Fernández MDM, Reyes Del Paso GA, Quirós-Ganga PL, Moreno-Salazar AS, Fernández-Serrano MJ. [Neuropsychological impairments in patients undergoing peritoneal dialysis treatment]. Med Clin (Barc) 2024; 162:147-156. [PMID: 38007389 DOI: 10.1016/j.medcli.2023.09.012] [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: 03/23/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Patients with chronic kidney disease on hemodialysis (HD) often have cognitive deficits. However, there are few studies that have examined the neuropsychological impairments of patients receiving peritoneal dialysis (PD). METHODS Executive functions, processing speed and verbal memory were assessed in 27 PD patients, 42 HD patients, and 42 healthy participants (HP). Systolic blood pressure and total time on renal replacement therapy (RRT) were controlled statistically. Associations between performance and clinical factors were analyzed using correlations and multiple regression. RESULTS The DP group showed better performance compared to the HD group in verbal fluency, working memory, cognitive flexibility, planning and decision making. The DP group showed worse execution than the HP group in verbal inhibition and memory. Executive function scores were positively associated with total months on PD, total months on RRT, total months on HD, albumin, total cholesterol, and phosphorus, and negatively with ferritin. CONCLUSION Global executive functioning was more optimal in PD patients than in HD patients. The results show the positive effect of PD on executive functions, which must be taken into account when choosing the TRS. The associations observed between biochemical factors and performance show the importance of maintaining an adequate nutritional status in these patients.
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Wang XH, He Y, Zhou H, Xiao T, Du R, Zhang X. Risk factors for cognitive impairment in patients with chronic kidney disease. World J Psychiatry 2024; 14:308-314. [PMID: 38464766 PMCID: PMC10921279 DOI: 10.5498/wjp.v14.i2.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients have been found to be at risk of concurrent cognitive dysfunction in previous studies, which has now become an important public health issue of widespread concern. AIM To investigate the risk factors for concurrent cognitive dysfunction in patients with CKD. METHODS This is a prospective cohort study conducted among patients with CKD between October 2021 and March 2023. A questionnaire was formulated by literature review and expert consultation and included questions about age, sex, education level, per capita monthly household income, marital status, living condition, payment method, and hypertension. RESULTS Logistic regression analysis showed that patients aged 60-79 years [odds ratio (OR) = 1.561, P = 0.015] and ≥ 80 years (OR = 1.760, P = 0.013), participants with middle to high school education (OR = 0.820, P = 0.027), divorced or widowed individuals (OR = 1.37, P = 0.032), self-funded patients (OR = 2.368, P = 0.008), and patients with hypertension (OR = 2.011, P = 0.041) had a higher risk of cognitive impairment. The risk of cognitive impairment was lower for those with a college degree (OR = 0.435, P = 0.034) and married individuals. CONCLUSION The risk factors affecting cognitive dysfunction are age, 60-79 years and ≥ 80 years; education, primary school education or less; marital status, divorced or widowed; payment method, self-funded; hypertension; and CKD.
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Affiliation(s)
- Xiao-Hui Wang
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Yong He
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Huan Zhou
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Ting Xiao
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Ran Du
- Department of Nephrology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
| | - Xin Zhang
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
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Zhang C, Cai Y, Yu H, Wu N, Liu J, Liang S, Zhang C, Duan Z, Zhang Z, Cai G. Comparison of the effects of peritoneal dialysis and hemodialysis on spontaneous brain activity in CKD patients: an rs-fMRI study. Cereb Cortex 2024; 34:bhad377. [PMID: 37948670 DOI: 10.1093/cercor/bhad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To compare the effects of peritoneal dialysis and hemodialysis on spontaneous brain activity in patients with end-stage renal disease. METHODS A total of 52 dialysis patients with end-stage renal disease, including 25 patients with chronic kidney disease undergoing hemodialysis (HD-CKD) and 27 patients with chronic kidney disease undergoing peritoneal dialysis (PD-CKD), and 49 healthy controls (normal control) were included. All participants underwent neuropsychological testing (Mini-Mental State Examination and Montreal cognitive assessment) and resting-state functional magnetic resonance imaging. Fractional amplitude of low frequency fluctuations and Regional Homogeneity algorithms were employed to evaluate spontaneous brain activity. Statistical analysis was performed to discern differences between the groups. RESULTS When compared with the normal control group, the PD-CKD group exhibited significant alterations in fractional amplitude of low frequency fluctuations in various cerebellum regions and other brain areas, while the HD-CKD group showed decreased fractional amplitude of low frequency fluctuations in the bilateral pericalcarine cortex. The Regional Homogeneity values in the PD-CKD group were notably different than those in the normal control group, particularly in regions such as the bilateral caudate nucleus and the right putamen. CONCLUSION Both peritoneal dialysis and hemodialysis modalities impact brain activity, but manifest differently in end-stage renal disease patients. Understanding these differences is crucial for optimizing patient care.
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Affiliation(s)
- Chaoyang Zhang
- Medical School of Chinese PLA, Beijing 100853, China
- First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Yan Cai
- Department of Nephrology, The Affiliated Hospital of Yangzhou University, Yangzhou 225001, China
| | - Huan Yu
- Department of Radiology, Liangxiang Hospital, Fangshan District, Beijing 102488, China
| | - Ning Wu
- Department of Medical Imaging, Yanjing Medical College, Capital Medical University, Beijing 100069, China
| | - Jiexi Liu
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Shuang Liang
- Medical School of Chinese PLA, Beijing 100853, China
- First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Chun Zhang
- Medical School of Chinese PLA, Beijing 100853, China
- First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Zhiyu Duan
- Medical School of Chinese PLA, Beijing 100853, China
- First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Zhou Zhang
- Medical School of Chinese PLA, Beijing 100853, China
- First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Guangyan Cai
- Medical School of Chinese PLA, Beijing 100853, China
- First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
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Zahr N, Pfefferbaum A. Serum albumin and white matter hyperintensities. RESEARCH SQUARE 2024:rs.3.rs-3822513. [PMID: 38260299 PMCID: PMC10802700 DOI: 10.21203/rs.3.rs-3822513/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Urine albumin, high in kidney disease, predicts cardiovascular incidents and CNS white matter hyperintensity (WMH) burdens. Serum albumin - a more general biomarker which can be low in several disorders - including kidney and liver disease, malnutrition, and inflammation - also predicts cardiovascular events and is associated with cognitive impairment in several clinical populations; relations between serum albumin and WMH prevalence, however, have rarely been evaluated. In a sample of 160 individuals with alcohol use disorder (AUD), 142 infected with HIV, and 102 healthy controls, the hypothesis was tested that lower serum albumin levels would predict larger WMH volumes and worse cognitive performance irrespective of diagnosis. After considering traditional cardiovascular risk factors (e.g., age, sex, body mass index (BMI), nicotine use, hypertension, diabetes) and study-relevant variables (i.e., primary diagnoses, race, socioeconomic status, hepatitis C virus status), serum albumin survived false discovery rate (FDR)-correction in contributing variance to larger periventricular but not deep WMH volumes. This relationship was salient in the AUD and HIV groups, but not the control group. In secondary analyses, serum albumin and periventricular WMH along with age, sex, diagnoses, BMI, and hypertension were considered for hierarchical contribution to variance in performance in 4 cognitive domains. Albumin survived FDR-correction for significantly contributing to visual and verbal learning and memory performance after accounting for diagnosis. Relations between albumin and markers of liver integrity [e.g., aspartate transaminase (AST)] and blood status (e.g., hemoglobin, red blood cell count, red cell distribution width) suggest that in this sample, albumin reflects both liver dysfunction and hematological abnormalities. The current results suggest that albumin, a simple serum biomarker available in most clinical settings, can predict variance in periventricular WMH volumes and performance in visual and verbal learning and memory cognitive domains. Whether serum albumin contributes mechanistically to periventricular WMH prevalence will require additional investigation.
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Chan FHF, Goh ZZS, Zhu X, Tudor Car L, Newman S, Khan BA, Griva K. Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis. Health Psychol Rev 2023; 17:614-640. [PMID: 36200562 DOI: 10.1080/17437199.2022.2132980] [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: 11/08/2021] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.
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Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zack Z S Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoli Zhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Dalal PK, Kar SK, Agarwal SK. Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases. Indian J Psychiatry 2022; 64:S394-S401. [PMID: 35602366 PMCID: PMC9122172 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1016_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pronob Kumar Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India E-mail:
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Yabe H, Okada K, Kono K, Imoto Y, Onoyama A, Ito S, Moriyama Y, Kasuga H, Ito Y. Effects of cognitive impairment and assisted peritoneal dialysis on exit-site infection in older patients. Clin Exp Nephrol 2022; 26:593-600. [PMID: 35195815 DOI: 10.1007/s10157-022-02199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 02/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Elderly peritoneal dialysis (PD) patients required assistance for a variety of PD-related tasks. The usefulness of assisted PD in reducing the peritonitis risk has been reported; however, there is little evidence on the effectiveness of assisted PD in preventing exit-site infections in older patients. METHODS This was a single-center, prospective cohort study. Thirty-three patients (mean age: 74.8 ± 5.9 years) on PD were evaluated for cognitive impairment (CI) using the Japanese version of the Montreal Cognitive Assessment. They were also evaluated to determine whether they performed the exit-site care procedure alone or with assistance. Patients were categorized into four groups based on the presence or absence of CI and the presence or absence of exit-site care assistance. They were followed up until the occurrence of peritonitis and exit-site infection at the end of the follow-up. RESULTS Altogether, 8, 8, and 17 patients were assigned to the "without CI and without assistance", "without CI and with assistance", and "with CI and with assistance groups", respectively; no patients were assigned to the "with CI and without assistance group". Six and 16 patients experienced peritonitis and exit-site infection during follow-up, respectively. Kaplan-Meier analysis and log-rank tests revealed that the "without CI and without assistance group" was significantly associated with exit-site infection (log-rank < 0.05). CONCLUSION Patients who did not receive assistance for exit-site care were at a higher risk of exit-site infections, even in the absence of CI. Caregiver assistance is important for preventing exit-site infections in older patients on PD.
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Affiliation(s)
- Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan. .,Department of Rehabilitation, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan.
| | - Keiko Okada
- Department of Nephrology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Kenichi Kono
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Yuto Imoto
- Department of Rehabilitation, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Ayaka Onoyama
- Department of Rehabilitation, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Sayaka Ito
- Department of Rehabilitation, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Hirotake Kasuga
- Department of Nephrology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan
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Tian X, Xia X, Yu H, Chen H, Jiang A, Xin L. Cognitive Dysfunction and Its Risk Factors in Patients Undergoing Maintenance Hemodialysis. Neuropsychiatr Dis Treat 2022; 18:2759-2769. [PMID: 36452115 PMCID: PMC9704003 DOI: 10.2147/ndt.s380518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cognitive impairment (CI) in Maintenance hemodialysis (MHD) is attracting increasing attention. This study aims to clarify the prevalence and risk factors for cognitive dysfunction in patients on MHD who have no history of stroke. METHODS A total of 99 patients with no history of stroke undergoing MHD were enrolled. Global cognitive function was evaluated using the Montreal Cognitive Assessment scale. Attention and executive functions were evaluated by the Digital Span (DS) test and the Color Trail Test (CTT). The Hamilton Depression and Anxiety scales were used to assess depression and anxiety status. The effects of patient background factors, laboratory indicators, anxiety, and depression on cognitive dysfunction were examined by regression analysis. RESULTS There were 69.70% of the patients had general CI, 65.65% had depression, and 57.57% had anxiety. The forward and backward DS in the cognitively impaired (CI) group were shorter than in the normal cognitive function (NCF) group (P<0.05). Times required for CTT-I, CTT-II, and CTT II - CTT I were longer in the CI group than in the NCF group (P<0.05). Hemoglobin levels were lower, and parathyroid hormone (PTH) and uric acid levels were higher in the CI group than in the NCF group (P<0.05). Hemoglobin levels were negatively correlated with CI in these patients (odds ratio [OR] 0.634, P<0.05) and PTH, and uric acid levels were positively correlated with CI (OR 1.028, P<0.05; and OR 1.011, P<0.05). The proportions of patients with diabetes and depression were higher in the CI group (P<0.05). CONCLUSION There was a high prevalence of CI with significant impairment of attention and executive ability in MHD patients who had no stroke history. Hemoglobin may protect cognitive function, while diabetes, PTH, and uric acid levels may be risk factors. Depressive and anxiety states may aggravate CI in MHD patients.
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Affiliation(s)
- Xiaolin Tian
- Department of Rehabilitation Medicine, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Haibo Yu
- Blood Purification Center, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Haiyan Chen
- Blood Purification Center, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Aili Jiang
- Blood Purification Center, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Li Xin
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
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Zhu JJ, Chen YJ, Chen LL, Zhao LJ, Zhou P. Factors that contribute to the cognitive impairment in elderly dialysis patients. Ther Apher Dial 2021; 26:632-639. [PMID: 34550646 DOI: 10.1111/1744-9987.13740] [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: 03/10/2021] [Revised: 09/11/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the cognitive function in dialysis patients over 60 years old and identify the contributing factors. METHODS A group of elderly dialysis patients in the Department of Nephrology, Pan'an People's Hospital between March 2015 and June 2018 were chosen as the subjects for this study. Patients were divided into two groups, those with cognitive impairment and those with normal cognitive function. Results of their Montreal Cognitive Assessment (MoCA) scores, Controlled Oral Word Association Test (COWAT), Wechsler Adult Intelligence Scale Digit Span subtest (WDMS), and Stanford Diagnostic Math Test (SDMT) were reviewed and analyzed. RESULTS Among the 110 elderly dialysis patients, 75 patients (68.18%) showed different levels of damage to their cognitive function. Their assessment scores on MoCA (total), MoCA subtests: visuospatial/executive, naming, attention, language, delayed recall, abstraction and orientation, COWAT (total), COWAT1, COWAT2, COWAT3, WMDS-Backward, and SDMT are significantly lower than patients with normal cognitive abilities (p < 0.05). Further analysis showed that the highest percentage (72.00%) of patients had impairment with visuospatial/executive function; and, of the 75 cognitive impaired patients, 37.33% showed cognitive damage in two MoCA subtests simultaneously. Patients with and without cognitive impairment showed a significant (p < 0.05) difference on factors including age, education level, employment status, financial situation, dialysis vintage, serum albumin, and hemoglobin. CONCLUSION Elderly patients on dialysis have a higher risk of becoming cognitive impaired. The cognitive impairment in elderly dialysis patients was significantly associated with age, dialysis vintage, and levels of serum albumin and hemoglobin.
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Affiliation(s)
- Jun-Jie Zhu
- Department of Nephrology, Pan'an People's Hospital, Jinhua, China
| | - Yang-Jin Chen
- Department of Nephrology, Pan'an People's Hospital, Jinhua, China
| | - Ling-Ling Chen
- Department of Nephrology, Pan'an People's Hospital, Jinhua, China
| | - Li-Jun Zhao
- Department of Nuclear Medicine, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ping Zhou
- Department of Nephrology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
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13
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Salazar-Félix NA, Martin-Del-Campo F, Cueto-Manzano AM, Romo-Flores ML, Velázquez-Vidaurri AL, Sánchez-Soriano A, Ruvalcaba-Contreras N, Calderón-Fabian A, Rojas-Campos E, Cortés-Sanabria L. Prevalence of mild cognitive impairment in automated peritoneal dialysis patients. Nephrol Dial Transplant 2021; 36:2106-2111. [PMID: 34375410 DOI: 10.1093/ndt/gfab238] [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: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive deterioration decreases quality of life, self-care and adherence to treatment, increasing mortality risk. There is scarce information of cognitive impairment in peritoneal dialysis, and data are controversial. OBJECTIVE To determine the frequency and associated factors of cognitive impairment in patients on automated peritoneal dialysis (APD). METHODS Cross-sectional study; 71 patients on APD underwent clinical, biochemical and cognitive function evaluation by means of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cognitive function was also evaluated in healthy controls. RESULTS Mean age was 42 ± 16 years, 79% were men and dialysis vintage was 17 (7-32) months. In APD patients, cognitive impairment was present in 7% (mild deterioration) and 68% according to the MMSE and MoCA, respectively, and in 4% and 37% in the healthy controls. Patients with cognitive impairment (according to MoCA) were older, with lower educational degree, had more frequently diabetes, and higher serum glucose, as well as lower serum creatinine, phosphorus and sodium concentrations than patients with normal cognitive function. In multiple linear regression analysis, predictors for the MoCA score (R2 0.63, p = 0.002) were schooling [B = 0.54 (0.20 to 0.89), p = 0.003], age [B=-0.11 (-0.21 to -0.01), p = 0.04], serum sodium [B = 0.58 (0.05 to 1.11), p = 0.03] and creatinine concentrations [B = 3.9 (0.03 to 0.83), p = 0.03]. CONCLUSION In this sample of APD patients with mean age in the early 40 s, the prevalence of cognitive impairment by MoCA test was 65%, and it was associated to older age, lower educational level and lower serum concentrations of sodium and creatinine.
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Affiliation(s)
- Noé A Salazar-Félix
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Fabiola Martin-Del-Campo
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - María L Romo-Flores
- Unidad de Diálisis Peritoneal, Hospital General Regional No. 46, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alma L Velázquez-Vidaurri
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Artemio Sánchez-Soriano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Neri Ruvalcaba-Contreras
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alejandro Calderón-Fabian
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Enrique Rojas-Campos
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
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14
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Mu J, Ma L, Ma S, Ding D, Li P, Ma X, Zhang M, Liu J. Neurological effects of hemodialysis on white matter microstructure in end-stage renal disease. NEUROIMAGE-CLINICAL 2021; 31:102743. [PMID: 34229157 PMCID: PMC8261074 DOI: 10.1016/j.nicl.2021.102743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To detect the effects of hemodialysis (HD) on the central nervous system (CNS), the present study forces the memory storage capacity and the difference in white matter (WM) microstructure characteristics among end-stage renal disease (ESRD) participants before HD initiation (ESRD-BHD), ESRD participants with maintenance HD (ESRD-MHD), and healthy participants (HCs). METHODS Between 2016 and 2018, 56 ESRD-BHD, 39 ESRD-MHD, and 56 HCs were recruited for this study. The fractional anisotropy (FA) of tractography streamlines within the working memory network was investigated using a novel along-tracts analysis method. The relationship between WM microstructure and working memory scores, measured from an n-back task, were detected by multiple correlation analysis. RESULTS As compared with HCs, a significantly lower FA was found along part of the WM in the working memory network in ESRD-BHD. In the group-difference location of ESRD-BHD and HCs, the FA of ESRD-MHD was reversed to normal levels in HCs. However, the FA in a new location was differentially reduced across groups: highest in HCs, intermediate in ESRD-BHD, and lowest in ESRD-MHD. Correlation analysis showed that a longer reaction time correlated to a lower FA, according to the following pattern: ESRD-BHD > ESRD-MHD > HCs. CONCLUSION Despite the persisting abnormal brain structure, our findings suggest HD has a neuroprotective effect in ESRD patients.
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Affiliation(s)
- 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 & Neuroimaging, Ministry of Education, Xi'an 710126, People's Republic of China
| | - Liang Ma
- 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 & Neuroimaging, Ministry of Education, Xi'an 710126, People's Republic of China
| | - Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Dun Ding
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Peng Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China; Department of Medical Imaging, Shaanxi Nuclear Geology 215 Hospital, Xianyang, People's Republic of China
| | - Xueying Ma
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, People's Republic of China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, 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 & Neuroimaging, Ministry of Education, Xi'an 710126, People's Republic of China.
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15
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Kitano T, Ito K, Ookawara S, Hoshino T, Hayasaka H, Kofuji M, Uchida T, Morino J, Minato S, Kaneko S, Yanai K, Mutsuyoshi Y, Ishii H, Matsuyama-Hirata M, Shindo M, Miyazawa H, Ueda Y, Hirai K, Morishita Y. Clinical factors affecting cerebral oxygenation in patients undergoing peritoneal dialysis. Int J Artif Organs 2021; 44:822-828. [PMID: 34058912 DOI: 10.1177/03913988211020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although cerebral regional oxygen saturation (rSO2) is significantly lower in hemodialysis (HD) patients than that in healthy controls, investigations on cerebral oxygenation in peritoneal dialysis (PD) patients are limited. We aimed to confirm the cerebral oxygenation status and identify the factors affecting cerebral rSO2 in PD patients. METHODS Thirty-six PD patients (21 men and 15 women; mean age, 62.8 ± 12.7 years) were recruited. In addition, 27 healthy volunteers (17 men and 10 women; mean age, 43.5 ± 18.8 years) were recruited as a control group. Cerebral rSO2 was monitored at the forehead using an INVOS 5100c oxygen saturation monitor. RESULTS Cerebral rSO2 was significantly lower in PD patients than that in healthy controls (57.0 ± 7.3% vs 68.9 ± 8.6%, p < 0.001); moreover, cerebral rSO2 was significantly correlated with natural logarithm (Ln)-PD duration (r = -0.389, p = 0.019) and serum albumin concentration (r = 0.370, p = 0.026) in a simple linear regression analysis. Multivariable linear regression analysis was performed using variables that showed a significant correlation and p < 0.20 (serum creatinine, serum sodium, Ln-C-reactive protein, and dosage of erythropoiesis-stimulating agent) with the cerebral rSO2. Cerebral rSO2 was independently associated with Ln-PD duration (standardized coefficient: -0.339) and serum albumin concentration (standardized coefficient: 0.316). CONCLUSIONS Cerebral rSO2 was significantly affected by the PD duration and serum albumin concentration. Further prospective studies are needed to clarify whether preventing a decrease in serum albumin concentration leads to the maintenance of cerebral oxygenation in patients undergoing PD.
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Affiliation(s)
- Taisuke Kitano
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Hoshino
- Department of Nephrology, Saitama Red-Cross Hospital, Saitama, Japan
| | - Hideyuki Hayasaka
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaya Kofuji
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takayuki Uchida
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junki Morino
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Saori Minato
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shohei Kaneko
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Katsunori Yanai
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Mutsuyoshi
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroki Ishii
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Momoko Matsuyama-Hirata
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsutoshi Shindo
- Department of Nephrology, Morishita Memorial Hospital, Kanagawa, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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16
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Risk factors for sleep disorders in patients undergoing peritoneal dialysis. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractSleep disorders in patients with end-stage renal disease are common but have rarely been reported in previous studies. Therefore, we examined the prevalence of sleep disorders and the risk factors for declining sleep quality in patients undergoing peritoneal dialysis (PD). A multicenter prospective cohort study was conducted at five PD centers across different provinces in China. A total of 449 patients who underwent PD between March to November 2013 were enrolled. Demographic data, laboratory indicators, presence of depression, and sleep assessment data were collected. Sleep questionnaires reflecting five categories of sleep disorders, namely, insomnia, restless legs syndrome, excessive daytime sleepiness, possible narcolepsy, and sleepwalking and nightmares, were administered at baseline and at 24 months postoperatively. Sleep disorders were diagnosed when a patient had at least one sleep problem. At baseline, 335 (74.6%) patients had at least one type of sleep disorder. Depression, diabetes mellitus (DM), and male were found to be associated with the presence of a sleep disorder. At follow-up, the prevalence of insomnia, restless legs syndrome, and excessive daytime sleepiness had significantly increased in 285 patients. Furthermore, cardiovascular disease (CVD) was found to be associated with the presence of sleep disorders in patients with one or more disorders at baseline, whereas a low serum albumin level was found to be associated with sleep disorders in patients without any sleep disorders at baseline. The prevalence of sleep disorders was relatively high among PD patients at baseline and increased afterthe2-year follow-up. Depression, DM, and male were associated with all sleep disorders at baseline. CVD was associated with the presence of a sleep disorder at baseline and worse sleep quality at the 2-year follow-up; whereas a low serum albumin level was associated with the risk of acquiring a sleep disorder at the 2-year follow-up among patients with normal sleep status at baseline.
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17
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Freire de Medeiros CMM, Diógenes da Silva BR, Costa BG, Sartori VF, Meneses GC, Bezerra GF, Martins AMC, Libório AB. Cognitive impairment, endothelial biomarkers and mortality in maintenance haemodialysis patients: a prospective cohort study. Nephrol Dial Transplant 2021; 35:1779-1785. [PMID: 32379316 DOI: 10.1093/ndt/gfaa040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Haemodialysis (HD) patients have a high prevalence of cardiovascular disease risk factors as well as cognitive impairment. The objective of the present study was to evaluate the interrelationship between cognitive impairment, endothelium-related biomarkers and cardiovascular/non-cardiovascular mortality. METHODS A total of 216 outpatients were recruited from three centres in a dialysis network in Brazil between June 2016 and June 2019. Sociodemographic and clinical data were obtained by applying a patient questionnaire, reviewing medical records data and conducting patient interviews. Cognitive function was assessed using the Cambridge Cognitive Examination. Plasma endothelium-related biomarkers [syndecan-1, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1) and angiopoietin-2 (AGPT2)] were measured. Patients were followed for 30 months. Cox proportional hazards regression models were used to assess the associations of the cognitive function scores and each endothelium-related biomarker with cardiovascular/non-cardiovascular mortality. RESULTS Cognitive function was associated with cardiovascular mortality {each standard deviation [SD] better cognitive score was associated with a 69% lower risk for cardiovascular mortality [hazard ratio (HR) 0.31 [95% confidence interval (CI) 0.17-0.58]} but not with non-cardiovascular mortality. Moreover, cognitive function was also correlated with all endothelial-related biomarkers, except VCAM-1. ICAM-1, AGPT2 and syndecan-1 were also associated with cardiovascular mortality. The association between cognitive function and cardiovascular mortality remained significant with no HR value attenuation [fully adjusted HR 0.32 (95% CI 0.16-0.59)] after individually including each endothelial-related biomarker in the Cox model. CONCLUSIONS In conclusion, cognitive impairment was associated with several endothelium-related biomarkers. Moreover, cognitive impairment was associated with cardiovascular mortality but not with non-cardiovascular mortality, and the association between cognitive impairment and cardiovascular mortality in HD patients was not explained by any of the endothelial-related biomarkers.
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Affiliation(s)
| | | | - Bruno Gabriele Costa
- Department of Internal Medicine, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil
| | - Vinicius Farina Sartori
- Department of Physiology and Pharmacology, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Gabriela Freire Bezerra
- Department of Physiology and Pharmacology, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alexandre Braga Libório
- Department of Internal Medicine, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil
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18
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Chu NM, Segev D, McAdams-DeMarco MA. Interventions to Preserve Cognitive Functioning Among Older Kidney Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2020; 7:346-354. [PMID: 33777649 PMCID: PMC7992368 DOI: 10.1007/s40472-020-00296-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To summarize the research on effective interventions for preserving cognitive function and prevent cognitive decline in patients with end-stage kidney disease (ESKD) who are undergoing dialysis and/or kidney transplantation (KT). RECENT FINDINGS Among ESKD patients undergoing hemodialysis, exercise training has been administered through home-based and intradialytic interventions. Additionally, one pilot study identified intradialytic cognitive training, electronic brain games, as an intervention to preserve cognitive function among patients undergoing hemodialysis. Fewer studies have investigated interventions to preserver cognitive function among KT recipients. To date, the only randomized controlled trial in this population identified B-vitamin supplements as an intervention to preserve cognitive function. The evidence from these trials support a short-term benefit of cognitive and exercise training as well as B-vitamin supplementation among patients with ESKD. Future studies should: 1) replicate these findings, 2) identify interventions specific to KT candidates, and 3) investigate the synergistic impact of both cognitive and exercise training. SUMMARY Cognitive prehabilitation, with cognitive and/or exercise training, may be novel interventions for KT candidates that not only reduces delirium risk and long-term post-KT cognitive decline but also prevents dementia.
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Affiliation(s)
- Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dorry Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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19
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Molnar AO, Bota SE, Garg AX, Ouédraogo A, Dixon SN, Naylor K, Oliver M, Sood MM. Dialysis Modality and Mortality in Heart Failure: A Retrospective Study of Incident Dialysis Patients. Cardiorenal Med 2020; 10:452-461. [PMID: 33238287 DOI: 10.1159/000511168] [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: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Prior studies reported lower mortality with hemodialysis (HD) compared to peritoneal dialysis (PD) in patients with heart failure (HF). We examined mortality rate by initial dialysis modality in incident dialysis patients with a history of HF using contemporary data and methods that ensure comparable HD and PD groups. METHODS Retrospective cohort study using administrative databases in Ontario, Canada. Adults (age 50-80) with a history of HF who initiated maintenance dialysis between April 1, 2007 and March 31, 2016 were included. We excluded patients typically ineligible for PD as an initial modality (dialysis start in hospital, dementia, long-term care facility residency). We determined the cause-specific hazard ratio (transplant as a competing event) between initial dialysis modality (HD vs. PD) and all-cause mortality using an intention-to-treat approach. RESULTS We included 2,199 patients with HF who initiated maintenance dialysis (77% HD and 23% PD). There were 1,152 (67.8%) and 340 (68.1%) mortality events over a median follow-up of 2.4 and 2.5 years in the HD and PD groups, respectively. Patients initiating HD versus PD was not associated with the mortality rate (adjusted hazard ratio 1.0, 95% CI 0.9-1.1). Similar results were seen in analyses censoring at modality switches and treating modality as time-varying. CONCLUSIONS We found no difference in mortality by initial dialysis modality. Our data support the current practice of selecting dialysis modality based on patient preference for patients with pre-existing HF.
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Affiliation(s)
- Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada, .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada, .,ICES, Toronto, Ontario, Canada,
| | | | - Amit X Garg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | | | | - Matthew Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Manish M Sood
- ICES, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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20
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Shin DJ, Kim T, Jung DU, Moon JJ, Jeon DW, Kim SJ, Kim YH, Kang SW, Kim Y. Association between Dialysis Adequacy and Cognition in Patients with Peritoneal Dialysis. Psychiatry Investig 2020; 17:1143-1148. [PMID: 33198435 PMCID: PMC7711114 DOI: 10.30773/pi.2020.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Cognition of peritoneal dialysis patients is influenced by various factors including dialysis adequacy such as fractional urea clearance (Kt/V) and relative overhydration (RelOH). This study aimed to discover the potential contribution of dialysis adequacy to cognitive function in patients undergoing peritoneal dialysis. METHODS Fifty-nine patients undergoing peritoneal dialysis were recruited. Demographic information, comorbidities, and clinical lab findings were retrospectively collected, and dialysis adequacy was determined by the Kt/V and RelOH calculation. Cognition and depression were measured with Digit Symbol Substitution Test, Hopkins Verbal Learning Test, Wechsler memory scale (spatial span), Wisconsin Card Sorting Test, and Beck's depression inventory. Partial correlation test was used to explore the correlation of dialysis adequacy with cognitive function. RESULTS RelOH showed significant correlation with some of the Wisconsin Card Sorting test results. The categories achieved showed negative correlation (r=-0.32, p=0.02) and trials to complete first category showed positive correlation (r=0.31, p=0.02) with RelOH. Other tasks showed no significant correlation with RelOH. Kt/V. CONCLUSION Our study demonstrates that peritoneal dialysis adequacy, measured by RelOH, seems to be significantly correlated with the occurrence of cognitive impairment. The outcome suggests that RelOH may have the potential to clarify the role of cognitive impairment in peritoneal dialysis patients.
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Affiliation(s)
- Dong Jin Shin
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Taehee Kim
- Division of Nephrology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung-Jin Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeong Hoon Kim
- Division of Nephrology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sun Woo Kang
- Division of Nephrology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yunmi Kim
- Division of Nephrology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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21
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Li Y, Pi HC, Yang ZK, Dong J. Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis. J Nephrol 2020; 33:839-848. [PMID: 31643008 PMCID: PMC7381472 DOI: 10.1007/s40620-019-00661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Uremic toxins have been suspected as potential contributors for cognitive impairment in peritoneal dialysis (PD) patients. However, associations between the clearance of serum small and middle molecules and the change of cognitive function were not fully explored and then we explored this issue in the present study. METHOD A total of clinically-stable 222 patients on PD were enrolled and then followed up for 2 years in this single-center prospective cohort study. Small and middle molecules clearances were examined by urea clearance (Kt/V), creatinine clearance (Ccr) and beta-2 microglobulin (B2M) clearance via dialysate and urine at baseline and after 2 years. Global and specific cognitive impairment were measured at baseline and after 2 years. Modified Mini-Mental State Examination (3MS) was assessed for global cognitive function, trail-making tests A and B for executive function and subtests of the battery for the assessment of neuropsychological status for immediate and delayed memory, visuospatial skills and language ability. RESULTS The median of total Kt/V, Ccr and B2M clearance were 1.89, 53.2 l/w/1.73 m2 and 17.5 l/w/1.73 m2, respectively at baseline. The prevalence of global cognitive impairment was 12.3% for 222 patients and 15.4% for the remained 130 patients after 2 years. At baseline, total Kt/V was independently positively associated with delayed memory function. Total and dialysate beta-2 microglobulin clearance was positively associated with 3MS scores and negatively with completion time on trail A after multivariate adjustment. At 2 years, we observed a significant difference in the changing trend of 3MS scores between groups divided by total B2M clearance (P = 0.033), which still maintained to be meaningful after multivariate adjustment (P = 0.024). Patients with total B2M clearance > 19.0 l/w/1.73 m2 got significant improvement on their 3MS scores (P = 0.005). Patients divided by total Kt/V or Ccr were not significantly different in the trends of general and any specific cognitive function during the follow up. CONCLUSION The higher middle molecules clearance independently correlated to better performance on general cognitive and executive function in PD patients, which also predict an improvement in general cognitive function during the follow up.
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Affiliation(s)
- Yi Li
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
- Renal Division, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hai-Chen Pi
- Emergency Department, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China.
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22
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Yang Z, Dong J. Operational considerations for peritoneal dialysis management during the COVID-19 pandemic. Clin Kidney J 2020; 13:322-327. [PMID: 32695321 PMCID: PMC7337678 DOI: 10.1093/ckj/sfaa085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 12/30/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by a novel coronavirus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is spread from human to human and has resulted in a global pandemic, posing a disastrous public health risk worldwide. Patients with chronic kidney disease, especially those on dialysis, are considered to be at higher risk of developing severe COVID-19 due to their immunocompromised status and frail condition. The home treatment setting of peritoneal dialysis (PD) has advantages in terms of implementing self-care when routine hospital visits and social activities are restricted, thus greatly reducing exposure of PD patients to the virus. Methods and Results We outline general operational considerations in PD management during the COVID-19 pandemic, including precautionary measures for PD patients and healthcare staff. Precautionary measures for PD patients include education on prevention of, and screening for, COVID-19, preclinic screening, in-clinic management, meticulous remote patient management and special hospitalization arrangements. The diagnosis and treatment of PD patients with COVID-19 are discussed. Precautionary measures for PD staff include continuous education on, and training in, COVID-19, exposure history surveillance and self-monitoring for COVID-19 among healthcare personnel, appropriate personal protective equipment and hand hygiene, organization of medical activities and staffing, and adequate environment cleaning. Conclusions This is a battle of the entire human society against the novel coronavirus. Integrated teamwork among healthcare providers, supported by society as a whole, is needed as part of the ongoing public health response to try to slow the spread of COVID-19.
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Affiliation(s)
- Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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23
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Tian R, Guo Y, Ye P, Zhang C, Luo Y. The validation of the Beijing version of the Montreal Cognitive Assessment in Chinese patients undergoing hemodialysis. PLoS One 2020; 15:e0227073. [PMID: 31917792 PMCID: PMC6952078 DOI: 10.1371/journal.pone.0227073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Cognitive impairment is common among hemodialysis patient, but still lack adequate screening in clinical settings. The Montreal Cognitive Assessment (MoCA) is reportedly to be a sensitive screening tool for cognitive impairment, but its clinical value in patients undergoing hemodialysis is not well established. We aimed to validate the utility of the Beijing version of the MoCA (MoCA-BJ) for detecting cognitive impairment in comparison to a detailed neuropsychological battery as the gold standard. Methods We assessed 613 patients undergoing hemodialysis using the MoCA-BJ, the Mini-Mental State Examination (MMSE), and a comprehensive neuropsychological battery. Cognitive dysfunction was defined by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Spearman’s correlation and linear regression were used to estimate the performance of the MoCA-BJ and MMSE in predicting cognitive impairment. A receiver operating characteristic (ROC) curve analysis was used to evaluate the utility of various cutoffs of the MoCA-BJ and MMSE for predicting cognitive impairment. Results Cognitive impairment was diagnosed in 80.91% (496/613), 75.69% (464/613), and 61.34% (376 /613) of the patients using the DSM-V, MoCA-BJ, and MMSE, respectively. Spearman’s rank correlation analysis indicated that the MoCA-BJ was significantly correlated with the neuropsychological battery (rs = 0.639, p<0.001), whereas the MMSE had a weaker correlation with the battery. The area under the ROC curve for cognitive impairment diagnosis using the MoCA-BJ was 0.891 (95% confidence interval: 0.859–0.924) while using the MMSE was 0.823 (95% confidence interval: 0.786–0.860). The optimal MoCA-BJ cutoff score in discriminating patients with and without cognitive impairment was 24 points with a sensitivity of 0.877 and specificity of 0.752. Conclusion The MoCA-BJ offers good sensitivity and specificity levels in detecting cognitive impairment in hemodialysis patients. These findings support the utility of the MoCA-BJ as a screening tool for cognitive impairment in Chinese patients undergoing hemodialysis.
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Affiliation(s)
- Ru Tian
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
| | - Yidan Guo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunxia Zhang
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
| | - Yang Luo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, China
- * E-mail:
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24
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Park BS, Kim SE, Lee HJ, Kim YW, Kim IH, Park JH, Park SH, Lee YJ, Seo SA, Park KM. Alterations in Structural and Functional Connectivities in Patients with End-Stage Renal Disease. J Clin Neurol 2020; 16:390-400. [PMID: 32657059 PMCID: PMC7354985 DOI: 10.3988/jcn.2020.16.3.390] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose The aim of this study was to evaluate the structural and functional connectivities of brain network using graph theoretical analysis in neurologically asymptomatic patients with end-stage renal disease (ESRD). We further investigated the prevalence of cognitive impairment (CI) in ESRD patients and analyzed the association between network measures of brain connectivity and cognitive function. Methods We prospectively enrolled 40 neurologically asymptomatic ESRD patients, 40 healthy controls, and 20 disease controls. All of the subjects underwent diffusion-tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). We calculated measures of structural and functional connectivities based on DTI and rs-fMRI, respectively, and investigated differences therein between the ESRD patients and the healthy controls. We assessed cognitive function in the ESRD patients using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery. Results The ESRD patients exhibited decreased global structural and functional brain connectivities, as well as alterations of network hubs compared to the healthy controls and disease controls. About 70% of the ESRD patients had CI. Moreover, ESRD patients without CI exhibited decreased global connectivity and alterations of network hubs. Furthermore, there was a significant positive association between measures of brain connectivity and cognitive function. Conclusions We found that ESRD patients exhibited decreased structural and functional brain connectivities, and that there was a significant association between brain connectivity and cognitive function. These alterations in the brain network may contribute to the pathophysiological mechanism of CI in ESRD patients.
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Affiliation(s)
- Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Il Hwan Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Hyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sol A Seo
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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25
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Kelly D, Rothwell PM. Disentangling the multiple links between renal dysfunction and cerebrovascular disease. J Neurol Neurosurg Psychiatry 2020; 91:88-97. [PMID: 31511306 PMCID: PMC6952845 DOI: 10.1136/jnnp-2019-320526] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
Chronic kidney disease (CKD) has a rapidly rising global prevalence, affecting as many as one-third of the population over the age of 75 years. CKD is a well-known risk factor for cardiovascular disease and, in particular, there is a strong association with stroke. Cohort studies and trials indicate that reduced glomerular filtration rate increases the risk of stroke by about 40% and that proteinuria increases the risk by about 70%. In addition, CKD is also strongly associated with subclinical cerebrovascular abnormalities, vascular cognitive impairment and dementia. The mechanisms responsible for these associations are currently unclear. CKD is associated with traditional risk factors such as hypertension, diabetes mellitus and atrial fibrillation, but non-traditional risk factors such as uraemia, oxidative stress, mineral and bone abnormalities, and dialysis-related factors, such as changes in cerebral blood flow or cardiac structure, are also postulated to play a role. Kidney disease can also impact and complicate the treatments used in acute stroke and in secondary prevention. In this review, we will outline our current understanding of the epidemiology and pathophysiology of cerebrovascular disease in CKD.
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Affiliation(s)
- Dearbhla Kelly
- Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Malcolm Rothwell
- Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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26
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van Zwieten A, Wong G, Ruospo M, Palmer SC, Teixeira-Pinto A, Barulli MR, Iurillo A, Saglimbene V, Natale P, Gargano L, Murgo M, Loy CT, Tortelli R, Craig JC, Johnson DW, Tonelli M, Hegbrant J, Wollheim C, Logroscino G, Strippoli GF, Cagnazzo A, Antinoro R, Sambati M, Donatelli C, Dambrosio N, Saturno C, Marangelli A, Pedone F, Matera G, Benevento M, Papagni S, Alicino F, Latassa G, Molino A, Grippaldi F, Bertino D, Montalto G, Messina S, Campo S, Nasisi P, Failla A, Bua A, Pagano S, Marino G, Sanfilippo N, Rallo D, Maniscalco A, Capostagno C, Randazzo G, Fici M, Lupo A, Fichera R, D'angelo A, Di Toro Mammarella R, Meconizzi M, Boccia E, Mantuano M, Flammini A, Moscardelli L. Associations of Cognitive Function and Education Level With All-Cause Mortality in Adults on Hemodialysis: Findings From the COGNITIVE-HD Study. Am J Kidney Dis 2019; 74:452-462. [DOI: 10.1053/j.ajkd.2019.03.424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/08/2019] [Indexed: 12/24/2022]
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27
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Zhao Y, Zhang Y, Yang Z, Wang J, Xiong Z, Liao J, Hao L, Liu G, Ren Y, Wang Q, Duan L, Zheng Z, Dong J. Sleep Disorders and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Kidney Blood Press Res 2019; 44:1115-1127. [PMID: 31537006 DOI: 10.1159/000502355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease experience a high burden of sleep disorders, and there are associations between sleep disorders and cognitive impairment. OBJECTIVES Based on our previous cross-sectional survey on cognitive impairment in peritoneal dialysis, we further explored the relationship between sleep disorders and cognitive impairment, and predictors for declining cognitive function. METHOD We conducted a multicenter prospective cohort study enrolling 458 clinically stable patients on peritoneal dialysis who were then followed up for 2 years.Demographic data, comorbidities, depression, and biochemistry data were collected at baseline. Sleep disorders including insomnia, restless legs syndrome, sleep apnea syndrome, excessive daytime sleepiness, possible narcolepsy, sleep walking and nightmares, and possible rapid eye movement behavior disorders were assessed using a panel of specific sleep questionnaires at baseline and in a second survey. Global cognitive function was measured at baseline and in a second survey, using the Modified Mini-Mental State Examination. Specific cognitive domains were evaluated using Trail-Making Test Forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status were used to asses immediate and delayed memory, visuospatial skills, and language ability. RESULTS Sleep disorders were common among peritoneal dialysis patients. The prevalence of cognitive impairment evaluated by the Modified Mini-Mental State Examination (3MS) increased from 19.8 to 23.9%. Possible narcolepsy was associated with decreased Modified Mini-Mental State Examination scores at baseline. During follow-up, sleepwalking and nightmares were associated with higher risks of declined delayed memory in the longitudinal study. CONCLUSIONS Possible narcolepsy was associated with general cognitive dysfunction, and sleep walking and nightmares were risk factors for impaired delayed memory.
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Affiliation(s)
- Youlu Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Yuhui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jinlan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Guiling Liu
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Yeping Ren
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Liping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | - Zhaoxia Zheng
- Renal Division, Handan Central Hospital, Hebei, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China, .,Institute of Nephrology, Peking University, Beijing, China, .,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China, .,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China,
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28
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Nie XD, Wang Q, Zhang YH, Xiong ZY, Liao JL, Hao L, Liu GL, Duan LP, Zheng ZX, Ren YP, Dong J. Depression at Baseline is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Perit Dial Int 2019; 39:465-471. [PMID: 31501292 DOI: 10.3747/pdi.2018.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients. Methods This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale. Results During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill. Conclusion Depression was a significant risk factor for worsening of CI in PD patients.
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Affiliation(s)
- Xue-dan Nie
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yu-hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zu-ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jin-lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-ling Liu
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Li-ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | | | - Ye-ping Ren
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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Voortman M, Hendriks CMR, Lodder P, Drent M, De Vries J. Quality of Life of Couples Living with Sarcoidosis. Respiration 2019; 98:373-382. [PMID: 31437834 PMCID: PMC6888889 DOI: 10.1159/000501657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Consequences of sarcoidosis are wide ranging, and the symptom burden has a great impact on patients' quality of life (QoL). However, the QoL of couples living with sarcoidosis has not yet been studied. OBJECTIVES Our aim was to assess the QoL of couples living with sarcoidosis and to evaluate whether living with a partner with sarcoidosis influences the partner's QoL. Furthermore, we aimed to assess whether nonspecific symptoms (fatigue, cognitive failure, small fiber neuropathy (SFN)-related symptoms, depressive symptoms, and state/trait anxiety) predict QoL of partners as well as sarcoidosis patients. METHOD Sarcoidosis outpatients, recruited at Maastricht University Medical Centre (n = 443), and their partners (n = 208) completed several questionnaires, including the World Health Organization QoL - BREF, Fatigue Assessment Scale, SFN screening list, and cognitive failure questionnaire. RESULTS QoL of the partners as well as the sarcoidosis patients was reduced compared with healthy controls, especially regarding the physical health domain. All nonspecific symptoms studied, as well as perceived social support, predicted one or more QoL domains in the sarcoidosis patients, but these factors did not predict the QoL of their partners. CONCLUSIONS The QoL of partners of sarcoidosis patients was reduced, although to a lesser extent than that of the patients. Although the nonspecific symptoms and perceived social support were related to the patients' QoL, this was not the case for the partners. In the management of sarcoidosis, it is important to focus not only on the patients but also on their partners.
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Affiliation(s)
- Mareye Voortman
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands,
- Department of Pulmonology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands,
- Mild care foundation research team, Ede, The Netherlands,
| | - Celine M R Hendriks
- Mild care foundation research team, Ede, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Marjolein Drent
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
- Mild care foundation research team, Ede, The Netherlands
- Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands
| | - Jolanda De Vries
- Mild care foundation research team, Ede, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Medical Psychology, ETZ (Elisabeth-TweeSteden Ziekenhuis) Tilburg, Tilburg, The Netherlands
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Chu NM, McAdams-DeMarco MA. Exercise and cognitive function in patients with end-stage kidney disease. Semin Dial 2019; 32:283-290. [PMID: 30903625 PMCID: PMC6606387 DOI: 10.1111/sdi.12804] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end-stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long-term adverse consequences, including dementia and death. Home-based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short-term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long-term follow-up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long-term health outcomes, including dementia prevention and better survival, are yet to be determined.
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Affiliation(s)
- Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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31
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Prevalence of cognitive impairment among peritoneal dialysis patients: a systematic review and meta-analysis. Clin Exp Nephrol 2019; 23:1221-1234. [DOI: 10.1007/s10157-019-01762-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 01/02/2023]
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32
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Duan LP, Zheng ZX, Zhang YH, Dong J. [Association of malnutrition-inflammation-cardiovascular disease with cognitive deterioration in peritoneal dialysis patients]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:510-518. [PMID: 31209424 DOI: 10.19723/j.issn.1671-167x.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between malnutrition-inflammation-atherosclerosis (MIA) syndrome and deterioration of global and specific domains of cognitive function in peritoneal dialysis (PD) patients. METHODS This was a multi-center prospective cohort study. The PD patients who met the inclusion criteria were examined with general and specific cognitive function between March 2013 and November 2013. The patients were divided into MIA0, MIA1 and MIA2 groups, according to items of "Yes" for whether or not having cardiovascular disease, serum albumin≤35 g/L or high-sensitive C-reactive protein (hs-CRP) ≥3 mg/L. After 2 years, the patients maintained on PD would be repeatedly measured with cognitive function. The Chi-square test, One-way ANOVA, Kruskal-wallis H rank sum test were used to compare the differences of clinical characteristics, biochemical data, and global and specific cognitive function parameters among the three groups at baseline, and two years later, respectively. The Bonferroni method was applied to adjust the significance level for further comparison between each two different groups. The change of score in each cognitive parameter of global and specific domains was used as dependent variable. Age, gender, education level, depression index, body-mass index, diabetes mellitus, serum sodium levels and MIA (MIA0 was control, MIA1 and MIA2 as dummy variables) were all included in the multivariable linear regression models to analyze the risk factors of the deterioration of cognitive function. The analysis for each cognitive domain was adjusted for the baseline score of the corresponding cognitive parameter. All the analyses were performed using SPSS for Windows, software version 25.0 (SPSS Inc., Chicago, IL). RESULTS Over two-year follow up, the prevalence of cognitive impairment increased from 20.0% to 24.7%, absolute decrease of 3MS scores were more significantly decreased in MIA2 (-3.9±12.0 vs. 1.1±6.7, P<0.01) and MIA1 group (-2.3±11.8 vs. 1.1±6.7, P<0.05) than those in MIA0 group respectively. Specific cognitive functions, included executive function (trail-making tests A and B, P=0.401, P=0.176), immediate memory (P=0.437), delayed memory (P=0.104), visuospatial skill (P=0.496), and language ability (P=0.171) remained unchanged. Advanced age, lower education, diabetes mellitus and depression were all correlated with the deterioration of one or more cognitive domains, and the patients having one item of MIA syndrome were prone to develop the deterioration of 3MS (P=0.022). Furthermore, the patients having two or more items of MIA syndrome were more likely to develop the deterioration of not only 3MS (P <0.001), but also delayed memory, visuospatial skill, and language ability (P=0.002, P=0.007, P=0.004, respectively). CONCLUSION Patients with one item or above of MIA syndrome were at high-risk for the deterioration of global cognitive function. The more MIA syndrome items there were, the more specific cognitive domains deteriorated.
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Affiliation(s)
- L P Duan
- Handan Central Hospital, Department 1 of Nephrology, Handan 056001, Hebei, China
| | - Z X Zheng
- Handan Central Hospital, Department 1 of Nephrology, Handan 056001, Hebei, China
| | - Y H Zhang
- Renal Division, Department of Medicine; Institute of Nephrology, Peking University First Hospital; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
| | - J Dong
- Renal Division, Department of Medicine; Institute of Nephrology, Peking University First Hospital; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China
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Kelly DM. The role of dialysis in the pathogenesis and treatment of dementia. Nephrol Dial Transplant 2018; 34:1080-1083. [DOI: 10.1093/ndt/gfy359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dearbhla M Kelly
- Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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