One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis

Song, Mi‐Kyung; Paul, Sudeshna; Ward, Sandra E.; Gilet, Constance A.; Hladik, Gerald A.

doi:10.1053/j.ajkd.2017.11.016

Cited by 27 publications

(33 citation statements)

References 36 publications

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“…In our study, we assessed functional status only at two time points: at the start and 6 months after start of dialysis. Because functional dependence can vary even in stable dialysis patients (33), more frequent assessments, including the predialysis phase and longer follow-up, are needed to elucidate the full functional trajectory and assess the effect of hospitalization or life events. In this study, we used a cut-off point of 1 as the definition of decline in functional status.…”

Section: Discussionmentioning

confidence: 99%

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Goto

Loon

Boereboom

et al. 2019

CJASN

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Background and objectives Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden. Design, setting, participants & measurements This study included participants aged $65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors. Results Of the 196 included participants functional data were available for 187 participants. Mean age was 7567 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%-38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death. Conclusions In patients aged $65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden.

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Section: Discussionmentioning

confidence: 99%

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Goto

Loon

Boereboom

et al. 2019

CJASN

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“…We found that mESRD exhibited greater memory than bESRD, but both were worse than HCs. Based on previous research, there were not yet able to provide an uncontested result whether cognition was improved or worsened during dialysis [51][52][53]. Based on the results of the neuropsychological tests, our results seemed to indicate that ESRD patients who underwent long-term dialysis have better cognitive function than ESRD patients before dialysis initiation.…”

Section: Discussionmentioning

confidence: 63%

Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

Zhang

Liu

et al. 2020

Preprint

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Abstract Background End-stage renal disease (ESRD) patients are at substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there did not provide an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), ESRD patients before dialysis initiation (bESRD) and those undergoing maintenance hemodialysis (mESRD). All ESRD patients performed a serious of blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K + and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in mESRD and bESRD groups. Results Neuropsychological analysis showed mESRD exhibited greater cognitive function than bESRD, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the bESRD and mESRD than the HCs. Besides, lower normalized clustering coefficient was in bESRD relative to the HCs and mESRD. For the GLMs analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in bESRD. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement. Cystatin C may be a risk feature of cognitive decline of bESRD.

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“…14 Many patients already have partially compromised cognition at dialysis initiation, [15][16][17] which further declines while undergoing treatment, 10,[18][19][20] and often fluctuates from month to month. 21 In fact, only 13% of prevalent HD patients were reported to have normal cognition 22 and clinicians often fail to recognize declining cognition among patients who are undergoing HD 23 or KT. 6 In fact, physicians were found to only accurately identify HD patients and KT recipients 57% 23 and 66% 6 of the time, respectively.…”

Section: Global Cognitive Function Among Patients With Eskdmentioning

confidence: 99%

“…In a cohort study of 324 adults aged 18 years and older initiating HD (mean age = 55), the average (SD) 3MS score for global cognitive function was 89.8 (7.6), which parallels scores of the most cognitively vulnerable group of community‐dwelling older adults aged 60 years and older . Many patients already have partially compromised cognition at dialysis initiation, which further declines while undergoing treatment, and often fluctuates from month to month . In fact, only 13% of prevalent HD patients were reported to have normal cognition and clinicians often fail to recognize declining cognition among patients who are undergoing HD or KT .…”

Section: Introductionmentioning

confidence: 99%

Exercise and cognitive function in patients with end‐stage kidney disease

Chu

McAdams‐DeMarco

2019

Seminars in Dialysis

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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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One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis

Abstract: Multidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.

Cited by 27 publications

References 36 publications

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis

Exercise and cognitive function in patients with end‐stage kidney disease

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