Cognitive impairment and associated risk factors in older adult hemodialysis patients: a cross-sectional survey

Luo, Yang; Murray, Anne M.; Guo, Yifan; Tian, Ru; Ye, Peng-Peng; Li, Xin; Li, Guogang; Lu, Fangping; Ma, Yingchun; Sun, Yi; Wang, Yuzhu; Xiao, Yijun; Zhang, Qimeng; Zhao, Xue-Feng; Zhao, Haidan; Chen, Xiangmei

doi:10.1038/s41598-020-69482-1

Cited by 30 publications

(29 citation statements)

References 34 publications

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“…Cognitive impairment (CI) is common in individuals with chronic kidney disease (CKD), especially in hemodialysis patients with end-stage renal disease (ESRD) (Murray et al, 2006). Previous studies including our own indicated that the prevalence of CI was ranged from 70 to 80%, which was significantly higher than those individuals with normal kidney function (Kurella Tamura et al, 2010;O'Lone et al, 2016;van Zwieten et al, 2018;Luo et al, 2020). Besides, CI was proved to be associated with adverse outcomes by means of influencing the compliance of hemodialysis patients regarding their dialysis schedules and medication regimens (Drew et al, 2015;Angermann et al, 2018).…”

Section: Introductionmentioning

confidence: 94%

Association Between Sleep Disorders and Cognitive Impairment in Middle Age and Older Adult Hemodialysis Patients: A Cross-Sectional Study

Tian

Bai

Guo

et al. 2021

Front. Aging Neurosci.

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Objective: The aims of the current study were to (1) explore the features of overall poor sleep and specific sleep disorders in Chinese middle age and older adult hemodialysis patients; (2) examine the association between sleep disorders and cognitive impairment (CI) in middle age and older patients undergoing hemodialysis in China.Methods: Data of patients undergoing maintenance hemodialysis were collected from the prospective cohort study of CI in Chinese patients undergoing hemodialysis (Registered in Clinical Trials.gov, ID: NCT03251573). We included 613 patients (mean age = 63.7; SD = 7.8) in this study. We assessed sleep conditions using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and cognitive function by the Chinese Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) scale. Then the association between sleep disorders and CI was evaluated using multivariate logistic regression analysis.Results: The prevalence of sleep disorders in this group of 613 hemodialysis patients was 77.0%. Patients with CI were more inclined to have sleep disorders in specific aspects of sleep latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction (p < 0.05). In multivariate logistic regression analyses, every 1-point increase in global PSQI score was associated with a 1.2-fold increased risk of CI (adjusted OR = 1.201; 95%CI = 1.123–1.284, p < 0.001). For each specific PSQI, every 1-point increase in sleep disturbances score was associated with a 2.6-fold increased risk of CI (adjusted OR = 2.624; 95%CI = 1.891–3.640, p < 0.001), and every 1-point increase in daytime dysfunction score was associated with a 3.7-fold increased risk of CI (adjusted OR = 3.709; 95%CI = 2.653–5.184, p < 0.001), whereas every 1-point increase in sleep duration score was associated with a decreased risk of CI (adjusted OR = 0.600; 95%CI = 0.434–0.830, p = 0.002).Conclusion: Poor sleep quality especially sleep disturbances, daytime dysfunction, and long sleep duration are associated with CI in middle age and older adult hemodialysis patients. Thus, the early detection of sleep disorders may help identify patients with cognitive impairment among hemodialysis individuals.Clinical Trial Registration: [Clinical Trials.gov], identifier [NCT03251573]

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Section: Introductionmentioning

confidence: 94%

Association Between Sleep Disorders and Cognitive Impairment in Middle Age and Older Adult Hemodialysis Patients: A Cross-Sectional Study

Tian

Bai

Guo

et al. 2021

Front. Aging Neurosci.

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“…Drew et al concluded that older age was the only risk factor for cognitive functions impairment in HD patients [3]. Age, education level, history of stroke and hypertension, dialysis vintage, and single-pool Kt/V were the main risk factors of CI in HD patients, according to Luo et al [48], while age and serum concentrations of Hb, cholesterol, and PTH were the main risk factors of CI as reported by Fadili et al [49].…”

Section: Discussionmentioning

confidence: 97%

Effect of Hemodiafiltration Versus Hemodialysis on Cognitive Function Among Patients With End-Stage Renal Disease: A Multicenter Study

Kashgary¹,

Khojah²,

Bamalan³

et al. 2021

Cureus

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Background: Cognitive impairment (CI) and dementia are common in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Their cause is multifactorial. Our study is first to compare the impact of hemodialysis (HD) and online hemodiafiltration (HDF) on patients’ cognitive outcomes. Methods: This was a cross sectional, multicenter cohort study. Adult ESRD patients aged >18 years on regular high flux HD or online HDF were recruited in the study. Clinical, laboratory, daily activities and cognitive functions assessment were assessed in all the involved individuals. Results: A total of 241 patients were successfully recruited into the study: 164 treated with high flux HD and 77 treated with HDF. Hypertension and diabetes were the commonest associated comorbidities. 85.9% of patients were functionally independent with no significant difference between those on HD versus HDF. 81.3% of our patients showed different degrees of CI. HDF has no superiority in the improvement of cognitive functions. Age, vitamin D level and haemoglobin (Hb) were the most independent predictors of cognitive function impairment among HD patients. Conclusions: Cognitive function impairment is a common problem in hemodialysis and is associated with multiple risk factors. HDF showed no beneficial effect over HD. There is no superiority of online HDF versus high flux HD in improving cognitive functions.

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“…In the Dialysis Outcomes and Practice Patterns Study, residual renal function was a significant factor in lowering the risk of dementia, suggesting that uremic toxin excretion through the kidneys may play a role in the development of dementia in these patients ( 8 ). In addition, in a recent cross-sectional analysis of Chinese dialysis patients, low spKt/V was found to be related to cognitive impairment ( 19 ). Nonetheless, a previous cross-sectional analysis evaluating patients enrolled in the Frequent Hemodialysis Network trials failed to reveal a close association between dialysis clearance of urea and cognitive function ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Dialysis Adequacy and Risk of Dementia in Elderly Hemodialysis Patients

et al. 2021

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Objective: Dementia is prevalent among elderly patients undergoing hemodialysis. However, the association between dialysis adequacy and the risk of dementia is uncertain.Methods: A total of 10,567 patients aged >65 years undergoing maintenance hemodialysis who participated in a national hemodialysis quality assessment program were analyzed. The patients were classified into quartile groups based on single-pool Kt/V levels. The associations between single-pool Kt/V and the development of dementia, Alzheimer's disease (AD), and vascular dementia (VD) were examined.Results: The mean age of the patients was 72.9 years, and 43.4% were female. The mean baseline single-pool Kt/V level was 1.6 ± 0.3. During a median follow-up of 45.6 (45.6–69.9) months, there were 27.6, 23.9, and 2.8 events/1,000 person-years of overall dementia, AD, and VD, respectively. The incidences of overall dementia, AD, and VD were lowest in the highest single-pool Kt/V quartile group. Compared with the lowest single-pool Kt/V quartile, the risks of incident overall dementia and AD were significantly lower in the highest quartile [sub-distribution hazard ratio (sHR): 0.69, 95% confidence interval (CI): 0.58–0.82 for overall dementia; sHR: 0.69, 95% CI: 0.57–0.84 for AD]. Inverse relationships were found between the risks of developing overall dementia and AD, and single-pool Kt/V. However, no significant relationship was observed between single-pool Kt/V levels and VD development.Conclusions: Increased dialysis clearance was associated with a lower risk of developing dementia in elderly hemodialysis patients.

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Cognitive impairment and associated risk factors in older adult hemodialysis patients: a cross-sectional survey

Cited by 30 publications

References 34 publications

Association Between Sleep Disorders and Cognitive Impairment in Middle Age and Older Adult Hemodialysis Patients: A Cross-Sectional Study

Association Between Sleep Disorders and Cognitive Impairment in Middle Age and Older Adult Hemodialysis Patients: A Cross-Sectional Study

Effect of Hemodiafiltration Versus Hemodialysis on Cognitive Function Among Patients With End-Stage Renal Disease: A Multicenter Study

Dialysis Adequacy and Risk of Dementia in Elderly Hemodialysis Patients

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