Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis

Chen, Yi; Lin, Jianxiong; Cao, Pengfei; Chen, Jingjing; Zhou, Ting; Yang, Ruiguo; Lu, Shuchao; Yu, Xueqing; Xiao, Yang

doi:10.1038/s41598-018-35548-4

Cited by 25 publications

(13 citation statements)

References 46 publications

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“…This phenomenon might be first explained by the underestimation of decline in cognitive function due to case bias from drop-outs (survivor bias). Other possible explanations for this phenomenon might be that participants included in this study had higher serum albumin levels (38.9 ± 3.2 g/l) as compared to those in previous studies [46]. Serum albumin level was an independently favorable factor to maintain the cognitive function as shown in our multicenter prospective cohort study [47].…”

Section: Discussionmentioning

confidence: 60%

Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis

Li¹,

Yang³

et al. 2019

J Nephrol

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Background Uremic toxins have been suspected as potential contributors for cognitive impairment in peritoneal dialysis (PD) patients. However, associations between the clearance of serum small and middle molecules and the change of cognitive function were not fully explored and then we explored this issue in the present study. Method A total of clinically-stable 222 patients on PD were enrolled and then followed up for 2 years in this single-center prospective cohort study. Small and middle molecules clearances were examined by urea clearance (Kt/V), creatinine clearance (Ccr) and beta-2 microglobulin (B2M) clearance via dialysate and urine at baseline and after 2 years. Global and specific cognitive impairment were measured at baseline and after 2 years. Modified Mini-Mental State Examination (3MS) was assessed for global cognitive function, trail-making tests A and B for executive function and subtests of the battery for the assessment of neuropsychological status for immediate and delayed memory, visuospatial skills and language ability. Results The median of total Kt/V, Ccr and B2M clearance were 1.89, 53.2 l/w/1.73 m 2 and 17.5 l/w/1.73 m 2 , respectively at baseline. The prevalence of global cognitive impairment was 12.3% for 222 patients and 15.4% for the remained 130 patients after 2 years. At baseline, total Kt/V was independently positively associated with delayed memory function. Total and dialysate beta-2 microglobulin clearance was positively associated with 3MS scores and negatively with completion time on trail A after multivariate adjustment. At 2 years, we observed a significant difference in the changing trend of 3MS scores between groups divided by total B2M clearance (P = 0.033), which still maintained to be meaningful after multivariate adjustment (P = 0.024). Patients with total B2M clearance > 19.0 l/w/1.73 m 2 got significant improvement on their 3MS scores (P = 0.005). Patients divided by total Kt/V or Ccr were not significantly different in the trends of general and any specific cognitive function during the follow up. Conclusion The higher middle molecules clearance independently correlated to better performance on general cognitive and executive function in PD patients, which also predict an improvement in general cognitive function during the follow up.

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Section: Discussionmentioning

confidence: 60%

Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis

Li¹,

Yang³

et al. 2019

J Nephrol

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“…35,36 Our results are consistent with these prior findings and highlight the effect of TMAO on the overall condition of the older population by focusing on cognitive frailty because studies have shown that older adults with cognitive frailty have a worse prognosis than those with cognitive impairment only. 37 Currently, only long-term physical activity can reduce cognitive frailty, 38 and neither a biomarker nor a targeted intervention for cognitive frailty has been proposed. Therefore, considering TMAO as a predictor of cognitive frailty can provide a novel prospect for future research on improving cognitive frailty.…”

Section: Figurementioning

confidence: 99%

<p>Trimethylamine N-Oxide, a Gut Microbiota-Dependent Metabolite, is Associated with Frailty in Older Adults with Cardiovascular Disease</p>

He¹,

Luo²,

Liu³

et al. 2020

CIA

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Objective: Our study aimed to explore the association between trimethylamine N-oxide and frailty in older adults with cardiovascular disease. Patients and Methods: This cross-sectional study analyzed a total of 451 people aged 65 years or older who underwent comprehensive geriatric assessments. Frailty status was determined using a frailty index constructed with 48 variables according to the cumulative deficits model. Physical frailty and cognitive frailty were also assessed in detail. Fasting plasma TMAO was measured by mass spectrometry. Results: The proportion of frail subjects was 29.9% (135/451). Plasma TMAO levels were significantly higher in frail patients than in nonfrail individuals (4.04 [2.84-7.01] vs 3.21 [2.13-5.03] µM; p<0.001). Elevated plasma TMAO levels were independently associated with the likelihood of frailty (OR 2.12, 95% CI 1.01-4.38, p=0.046). Dose-response analysis revealed a linear association between the TMAO concentration and the OR for frailty. A 2-unit increase in TMAO was independently correlated with physical frailty (OR 1.23, 95% CI 1.08-1.41, p for trend 0.002) and cognitive frailty (OR 1.21, 95% CI 1.01-1.45, p for trend 0.04). Conclusion: Elevated circulating TMAO levels are independently associated with frailty among older adults with cardiovascular disease.

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“…Prior studies have demonstrated that the presence of comorbid diseases and lower serum albumin levels are significant risk factors for mortality in elderly patients receiving PD [ 27 , 28 ]. Previously we reported that older age, diabetes, CVD and malnutrition are associated with both frailty and cognitive impairment among patients on continuous ambulatory PD and that the coexisting frailty and cognitive impairment is related to decreased patient survival rate [ 29 ]. In the present study, elderly patients in the early-start group had a higher proportion of diabetes and lower serum albumin compared with the late-start group, which may partly explain the increased mortality of elderly patients with early dialysis.…”

Section: Discussionmentioning

confidence: 99%

Early initiation of PD therapy in elderly patients is associated with increased risk of death

Peng

Chen

et al. 2020

Clinical Kidney Journal

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Background The effect of early initiation of dialysis on outcomes of patients with end-stage renal disease (ESRD) remains controversial. We conducted this study to investigate the association between the timing of peritoneal dialysis (PD) initiation and mortality in different age groups. Methods In this single-centre cohort study, incident patients receiving PD from 1 January 2006 to 31 December 2016 were enrolled. Patients were categorized into three groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD, with early, mid and late initiation of PD defined as eGFR ≥7.5, 5–7.5 and <5 mL/min/1.73 m2, respectively. Results A total of 2133 incident patients receiving PD were enrolled with a mean age of 47.1 years, 59.6% male and 25.3% with diabetes, of whom 1803 were young (age <65 years) and 330 were elderly (age ≥65 years). After multivariable adjustment, the overall and cardiovascular (CV) mortality risks for young patients receiving PD were not significantly different between these three groups. However, for elderly patients, early initiation of PD therapy was associated with increased risks of all-cause {hazard ratio [HR} 1.54 [95% confidence interval (CI) 1.06–2.25]} and CV [HR 2.07 (95% CI 1.24–3.48)] mortality compared with late initiation of PD, while no significant difference was observed in overall or CV mortality between the mid- and late-start groups. Conclusions No significant difference in mortality risk was found among the three levels of eGFR at PD therapy initiation in young patients, while early initiation of PD was associated with a higher risk of overall and CV mortality among elderly patients.

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Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis

Cited by 25 publications

References 46 publications

Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis

Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis

<p>Trimethylamine N-Oxide, a Gut Microbiota-Dependent Metabolite, is Associated with Frailty in Older Adults with Cardiovascular Disease</p>

Early initiation of PD therapy in elderly patients is associated with increased risk of death

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