Prevalence of Cognitive Impairment in Patients Attending Pre‐dialysis Clinic

Abstract

Approximately 20-30% of patients on renal replacement therapy (RRT) have cognitive impairment. Less is known about the prevalence of cognitive impairment in patients with advanced kidney disease awaiting the initiation of dialysis. Routine cognitive assessment was implemented in the pre-dialysis clinic, which enabled the Nephrologist and Pre-dialysis Nurse to identify those patients with impaired cognitive function and utilise this information to assess the suitability for self-care treatments, such as peritoneal dialysis, as well as to adapt information to meet their needs. Subsequently, a cross-sectional single-centre audit was undertaken to identify the prevalence of cognitive impairment in 132 consecutive new referrals to the pre-dialysis clinic using the Mini-mental State Examination (MMSE). Twenty percent (95% CI = 0.13, 0.27) were classified as cognitively impaired. Those with cognitive impairment were significantly older, and had lower eGFR and higher serum creatinine. It can be concluded that approximately 1 in 5 patients attending the pre-dialysis clinic has cognitive impairment, which may not be apparent on a routine clinical history. Cognitive function assessment is recommended for all, but particularly to the older patient, before advising on choice of dialysis modality or opting for conservative treatment.

Prevalence and determinants of cognitive impairment in patients with chronic kidney disease: A cross-sectional study in Benin City, Nigeria

“…However, a recent study by Williams et al similarly showed a high prevalence of CI among Nigerians using the community screening instrument for dementia) and the trail making tests A and B. [23] Our findings are higher than the 20% prevalence rates found in a London clinic [24] and the 17% and 22% found among predialytic and ESRD patients, respectively in California [13] Using the same neuropsychological tool as we did, Etgen et al have reported a lower prevalence of 10.8% at baseline in their prospective cohorts who were inhabitants of Germany. It is therefore possible that there may be racial predisposition to CI.…”

“…[35] Quite surprisingly, age and presence of hypertension showed no association with CI in our study unlike in the previous reports. [24,29] The fact that patients with severely elevated BPs were excluded from the study many have contributed to this finding. Furthermore, this finding is not exclusive.…”

“…Several previous reports have suggested that CI may be more prevalent in older CKD patients. [24,35] The study had some limitations. The 6ICT measures global cognition and does not evaluate specific cognitive domains.…”

Cognitive Impairment in Chronic Kidney Disease-Prevalence, Mechanisms and Consequences

“…Interestingly, patients with early stages of CKD already show cognitive impairment [20]. Depending on CKD stage, CKD is frequently associated with prevalence of cognitive impairment in different domains including executive function, information processing speed, memory and language, which range from 17% to 87% [7,[9][10][11][12][13][14][15].…”

“…Regarding consequences of CKD, most studies concentrate on cardiovascular morbidity and mortality [6], while cognitive function, which is an important determinant of adherence to CKD therapy, is often overlooked [7]. Cognitive impairment in CKD is getting an increasingly relevant topic for healthcare systems, since CKD prevalence worldwide is estimated to be about 12% [8] and cognitive impairment to affect 17% to 87% of CKD patients, depending on CKD severity [7,[9][10][11][12][13][14][15].…”