Cognitive Impairment in Advanced Chronic Kidney Disease: The Canadian Frailty Observation and Interventions Trial

Abstract

Background: Chronic kidney disease (CKD) affects more than one third of older adults, and is a strong risk factor for vascular disease and cognitive impairment. Cognitive impairment can have detrimental effects on the quality of life through decreased treatment adherence and poor nutrition and results in increased costs of care and early mortality. Though widely studied in hemodialysis populations, little is known about cognitive impairment in patients with pre-dialysis CKD. Methods: Multicenter, cross-sectional, prospective cohort study including 385 patients with CKD stages G4-G5. Cognitive function was measured with a validated tool called the Montreal Cognitive Assessment (MoCA) as part of a comprehensive frailty assessment in the Canadian Frailty Observation and Interventions Trial. Cognitive impairment was defined as a MoCA score of ≤24. We determined the prevalence and risk factors for cognitive impairment in patients with CKD stages G4-G5, not on dialysis. Results: Two hundred and thirty seven participants (61%) with CKD stages G4-G5 had cognitive impairment at baseline assessment. When compared to a control group, this population scored lower in all domains of cognition, with the most pronounced deficits observed in recall, attention, and visual/executive function (p < 0.01 for all comparisons). Older age, recent history of falls and history of stroke were independently associated with cognitive impairment. Conclusions: Our study uncovered a high rate of unrecognized cognitive impairment in an advanced CKD population. This impairment is global, affecting all aspects of cognition and is likely vascular in nature. The longitudinal trajectory of cognitive function and its effect on dialysis decision-making and outcomes deserves further study.

Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait‐listing

“…Cognitive impairment, as measured by the MoCA, was highly prevalent in our pretransplant evaluation population which consisted mainly of Hispanics and Native Americans. This finding is consistent with previous studies showing that cognitive impairment is prevalent in the dialysis population and also confirmed the study by Sequist et al that Native Americans are less likely to be placed on the wait‐list compared with Whites. We found that advanced age, low education level and being on dialysis at the time of evaluation were associated with cognitive impairment.…”

The effect of the interdialytic interval on cognitive function in patients on haemodialysis

“…Cognitive impairments are frequently observed among individuals undergoing haemodialysis (HD) (Griva et al ; Lux et al ; Song et al ; Zammit et al ; Foster et al ; O’lone et al ; Drew et al . ; Iyasere et al ).…”

“…Cognitive impairments are frequently observed among individuals undergoing haemodialysis (HD) (Griva et al 2010;Lux et al 2010;Song et al 2011;Zammit et al 2015;Foster et al 2016;O'lone et al 2016;Drew et al 2017;Iyasere et al 2017). Such deficits may take the form of memory and attention impairment, reduced psychomotor speed and accuracy, and reduced mental efficiency (O'lone et al 2016;Drew et al 2017).…”

Human factors testing of the Quanta SC+ hemodialysis system: An innovative system for home and clinic use

“…For example, 55% of the dialysis population has some form of diabetes, which in turn is associated with peripheral neuropathy, carpal tunnel syndrome, arthritis, and macular degeneration. Additionally, given that the overall mean age at dialysis initiation is approximately 64 years old, rates of cognitive impairment are estimated to affect a significant proportion of dialysis patients; cognitive impairment affects a person's judgment and dexterity, hindering their ability to self‐manage complicated HHD systems. Moreover, although self‐care can promote self‐empowerment, an individual's support network often needs to be involved in a patient's care; and indeed this is reflected in several studies that suggest home dialysis users tend to be younger and married or cohabitating, with fewer comorbidities …”