Chronic kidney disease, 24-h blood pressure and small vessel diseases are independently associated with cognitive impairment in lacunar infarct patients

Yamamoto, Yasumasa; Ohara, Tomoyuki; Nagakane, Yoshinari; Tanaka, Eijiro; Morii, Fukiko; Koizumi, Takashi; Akiguchi, Ichiro

doi:10.1038/hr.2011.118

Cited by 29 publications

(24 citation statements)

References 35 publications

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“…23,24 In the general population of older adults, insulin resistance in particular has been associated with decreased physical performance 6,25 and with risk for cerebrovascular disease 26 and cardiovascular disease in nonpatients with diabetes, 27 but the role of insulin resistance to physical performance and vascular disease in CKD patients is less clear. Nonetheless, given the well described association between CKD, cognitive impairment, and subclinical cerebrovascular disease, [28][29][30] it is possible that simple, objective measures of lower extremity physical performance reflect the cumulative multisystem comorbid burden associated with CKD and improve assessment of mortality risk. Our study had several limitations.…”

Section: Discussionmentioning

confidence: 99%

Association between Physical Performance and All-Cause Mortality in CKD

Roshanravan

Robinson‐Cohen

Patel

et al. 2013

Journal of the American Society of Nephrology

374

314

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In older adults, measurements of physical performance assess physical function and associate with mortality and disability. Muscle wasting and diminished physical performance often accompany CKD, resembling physiologic aging, but whether physical performance associates with clinical outcome in CKD is unknown. We evaluated 385 ambulatory, stroke-free participants with stage 2-4 CKD enrolled in clinicbased cohorts at the University of Washington and University of Maryland and Veterans Affairs Maryland Healthcare systems. We compared handgrip strength, usual gait speed, timed up and go (TUAG), and 6-minute walking distance with normative values and constructed Cox proportional hazards models and receiver operating characteristic curves to test associations with all-cause mortality. Mean age was 61 years and the mean estimated GFR was 41 ml/min per 1.73 m 2 . Measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. Fifty deaths occurred during the median 3-year follow-up period. After adjustment, each 0.1-m/s decrement in gait speed associated with a 26% higher risk for death, and each 1-second longer TUAG associated with an 8% higher risk for death. On the basis of the receiver operating characteristic analysis, gait speed and TUAG more strongly predicted 3-year mortality than kidney function or commonly measured serum biomarkers. Adding gait speed to a model that included estimated GFR significantly improved the prediction of 3-year mortality. In summary, impaired physical performance of the lower extremities is common in CKD and strongly associates with all-cause mortality. CKD is a growing global health problem that affects .25 million US adults. 1 CKD leads to the retention of metabolic waste products and hormonal disturbances that adversely affect multiple target organ systems, including skeletal muscle. A major consequence of loss of skeletal muscle (sarcopenia) is skeletal muscle dysfunction, which is associated with impaired mobility and reduced physical performance. Among general older adult populations, decreased physical performance is independently associated with subsequent disability, fracture, falls, hospitalization, and mortality. [2][3][4] In particular, usual gait speed has been used as an adjunct for risk stratification by quantifying the burden of recognized and unrecognized multisystem comorbidity,

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Section: Discussionmentioning

confidence: 99%

Association between Physical Performance and All-Cause Mortality in CKD

Roshanravan

Robinson‐Cohen

Patel

et al. 2013

Journal of the American Society of Nephrology

374

314

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“…Progressive cognitive decline appears to progress faster in patients with CKD than in those without (probably because of the high burden of vascular disease), such that by the time patients are established on dialysis, .30% have severe cognitive impairment consistent with dementia (8,10,11). However, for multiple reasons, cognitive impairment and dementia are often under-recognized and underdocumented in medical charts (12,13).…”

Section: Case Historymentioning

confidence: 99%

Should an Elderly Patient with Stage V CKD and Dementia Be Started on Dialysis?

Ying

Levitt

Jassal

2014

Clinical Journal of the American Society of Nephrology

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The burden of cognitive impairment appears to increase with progressive renal disease, such that the prevalence of dementia among those starting dialysis, or those already established on dialysis, is high. The appropriateness of dialysis initiation in this population has been questioned, and current Renal Physician Association guidelines suggest forgoing dialysis in individuals who have dementia and lack awareness of self and environment. Patients are, however, also entitled to equal rights and respect, equal access to health care services, and an opportunity to engage in shared decision-making processes, particularly if there is concern over reversibility of disease. This article discusses, on the basis of principles of beneficence and nonmaleficence, the arguments in favor of and against dialysis use, and the process of determining an appropriate care plan. Factors discussed include the current societal trend toward a technological imperative, premature fatalism, survival benefits, and the implications of providing care to patients who are unable to express their tolerance for symptoms associated with the treatment or lack of treatment.

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“…[3][4][5] Thus, because the association between blood pressure (BP) and cerebrovascular and cardiovascular disease may be marked in patients with CKD, it is essential to strictly control the BP, including the ambulatory BP profile, in patients with CKD, through lifestyle modification and proper clinical treatment, to prevent cerebrovascular and cardiovascular disease. [6][7][8] Albuminuria and glomerular filtration rate are the key components of the assessment of the severity of CKD. These parameters are also closely associated with the ambulatory BP profile, 9 and they have prognostic significance for the development of cardiovascular disease (CVD).…”

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confidence: 99%