Hyponatremia and Cognitive Impairment in Patients Treated with Peritoneal Dialysis

Xu, Rong; Pi, Hai-Chen; Xiong, Zuying; Liao, Jinlan; Hao, Li; Liu, Guiling; Ren, Ye-Ping; Wang, Qin; Zheng, Zhaoxia; Duan, Liping; Dong, Jie

doi:10.2215/cjn.02240215

Cited by 49 publications

(37 citation statements)

References 44 publications

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“…Our results regarding the extent of CI are similar to previous studies showing that CI is more common in those undertaking HD , in those who are older, and that CI was equally common in adequately dialysed peritoneal and HD patient groups . However, our results regarding the extent of CI in those undertaking peritoneal dialysis is higher than almost all previous studies published . We speculate that the variations from previous studies on the prevalence of CI in PD are the result of using different assessment tools or applying different study methods when using the MoCA.…”

Section: Discussionsupporting

confidence: 85%

“…35 However, our results regarding the extent of CI in those undertaking peritoneal dialysis is higher than almost all previous studies published. 12,14,[36][37][38] We speculate that the variations from previous studies on the prevalence of CI in PD are the result of using different assessment tools or applying different study methods when using the MoCA. For example, previous work by Shea et al 12 using the MoCA to screen for CI in those receiving PD in Hong Kong, utilized a cut-off of 21 or 22/30 based on previous validation studies in their setting, compared with a cut-off of ≤ 24/30 in this study.…”

Section: Discussionmentioning

confidence: 91%

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Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross‐sectional study from Australia

et al. 2017

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 91%

Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross‐sectional study from Australia

et al. 2017

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“…However, even mild declines in serum sodium level can have adverse consequence upon the central nervous system, including disequilibrium, gait abnormalities, fall and fracture risk [1,[26][27][28][29]. Indeed, a recent cross-sectional study of 472 PD patients showed that hyponatremia was associated with cognitive impairment ascertained by various formal testing methods [4]. Emerging data also suggest that hyponatremia leads to derangements in cardiac conduction and function, owing to inhibition of calcium channel circuits [30].…”

Section: Discussionmentioning

confidence: 99%

“…In comparison with the general population, observational data show that pre-dialysis CKD and hemodialysis patients have a 2-fold higher prevalence of hyponatremia compared with the general population, likely resulting from volume overload, excess free water intake, impaired free water clearance, protein-energy wasting and co-existing illnesses (e.g. congestive heart failure, cirrhosis) [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Serum sodium and mortality in a national peritoneal dialysis cohort

Ravel

Streja

Mehrotra

et al. 2016

Nephrol. Dial. Transplant.

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A B S T R A C TBackground: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo-and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients. Methods: We sought to examine the association of serum sodium over time and mortality among 4687 adult incident PD patients from a large US dialysis organization who underwent one or more serum sodium measurements within the first 3 months of dialysis over January 2007 to December 2011. We examined the association of time-dependent and baseline sodium with allcause mortality as a proxy of short-and long-term sodium-mortality associations, respectively. Hazard ratios were estimated using Cox models with three adjustment levels: minimally adjusted, case-mix adjusted, and case-mix þ laboratory adjusted. Results: In time-dependent analyses, sodium levels <140 mEq/ L were associated with incrementally higher death risk in casemix models (ref: 140 to <142 mEq/L); following laboratory covariate adjustment, associations between lower sodium and higher mortality remained significant for levels <136 mEq/L. In analyses using baseline values, sodium levels <140 mEq/L were associated with higher mortality risk across all models (ref: 140 to <142 mEq/L). Conclusions: In PD patients, lower time-dependent and baseline sodium levels were independently associated with higher death risk. Further studies are needed to determine whether correction of dysnatremia improves longevity in this population.

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“…In multivariate analysis, after adjustment for recognized influence factors [29,30], include age, education, CVD history, DM, serum albumin, and serum sodium levels, these neuroimaging findings still independently predicted a higher risk for global CI, with a hazard ratio (HR) of 1.80 (1.22-2.64), 1.67 (1.09-2.57), and 2.49 (1.07-5.77), respectively. Table 2.…”

Section: Associations Between Cognitive Function and Structural Neuromentioning

confidence: 99%

Cognitive Impairment and Structural Neuroimaging Abnormalities Among Patients with Chronic Kidney Disease

et al. 2016

Kidney Blood Press Res

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Background/Aims: Cognitive impairment and abnormal structural neuroimaging is common in chronic kidney disease patients. We aimed to explore its association with dialysis modality and the relationship between cognitive impairment and abnormal structural neuroimaging. Methods: Sixty peritoneal dialysis patients and 30 hemodialysis and 30 non-dialyzed stage 3-5 chronic kidney disease patients without history of stroke were enrolled for the study. Participants were matched for age, gender, education, diabetes status, and dialysis duration (if appropriate). Cognitive functions were measured using a battery of recognized instruments. Brain features were examined with 3-dimensional magnetic resonance imaging. Results: Cognitive impairment was significantly more severe in dialysis patients than in non-dialyzed patients. The global and specific cognitive function were not significantly different between patients on peritoneal dialysis and hemodialysis. Hemodialysis patients had more severe white matter hyperintensity, sulcal and ventricular atrophy, and SVIs than other patients. In all groups, higher white matter grade, ventricular grade, and hippocampal atrophy were significantly associated with global cognitive impairment, with hazard ratios of 1.80 (1.22-2.64), 1.67 (1.09-2.57), and 2.49 (1.07-5.77), respectively. White matter grade was also significantly associated with delayed memory (hazard ratio 1.63; 1.12-2.39). Conclusion: Dialysis modality showed no association with cognitive impairment, although hemodialysis patients had more severe neuroimaging abnormalities. For the whole group, white matter hyperintensity, and ventricular and hippocampal atrophy, were independently associated with global cognitive impairment in chronic kidney disease patients.

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Hyponatremia and Cognitive Impairment in Patients Treated with Peritoneal Dialysis

Abstract: Hyponatremia was associated with global and specific cognitive impairment in PD patients.

Cited by 49 publications

References 44 publications

Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross‐sectional study from Australia

Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross‐sectional study from Australia

Serum sodium and mortality in a national peritoneal dialysis cohort

Cognitive Impairment and Structural Neuroimaging Abnormalities Among Patients with Chronic Kidney Disease

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