Prevalence of Cognitive Impairment in Peritoneal Dialysis Patients and Associated Factors

Abstract

Background. Cognitive impairment (CI) in patients with chronic kidney disease, including those treated with renal replacement therapy (RRT) is a growing problem worldwide. The study aimed to assess the prevalence of CI and associated factors in patients undergoing peritoneal dialysis (PD). Methods. In this cross-sectional study, 18 consecutive patients with PD therapy and 15 controls were evaluated for CI using the Addenbrooke's Cognitive Examination III (ACE III) test. Results. The prevalence of CI was 33% in patients and 27% in the control group and was not statistically significant. A higher prevalence of CI was found in subjects aged ≥65 years old than in those <65years old (p = 0.02), but only in the control group. The prevalence of CI in PD patients over and under 65 years of age did not differ statistically significantly (p = 0.12). Memory and verbal fluency were the most affected cognitive domain in PD patients with CI (p = 0.00, p = 0.04, respectively). There was a significant correlation between higher-educated PD patients and the ACE III test results. The duration of dialysis did not affect the results of the cognitive screening test. Conclusion. Cognitive impairment is a growing problem in the course of chronic kidney disease and dialysis therapy. It seems that cognitive problems may occur in patients undergoing peritoneal dialysis at a younger age than in the general population with particularly affected memory and verbal fluency. Higher-educated patients score better on the cognitive screening test.

The Clock Drawing Task reveals executive dysfunction in the dialysis population – an underrecognized and underestimated problem

“…patients with ESKD demonstrated problems in tests assessing executive function in the first months of RRT, while there were no difficulties in general cognitive skills [ 27 ]. Furthermore, a few studies, assessing cognitive abilities in CKD patients, including our previously published study, found verbal fluency to be the most affected domain, which reflects executive dysfunction [ 3 , 4 , 14 ].…”

“…Age is also a strong predictor of cognitive dysfunction. The prevalence of CI in patients on RRT is higher than in CKD patients and is highest in hemodialysis patients (HD) in comparison to peritoneal dialysis (PD) and kidney transplant recipients [ 3–5 ]. On the other hand, the prevalence of CI may be underestimated due to the exclusion of patients with severe disabilities such as vision and hearing problems, language and movement disorders, language barrier, as well as patients who refused to participate in the cognitive assessment [ 6 ].…”

“…Vascular dementia (VaD) may contribute to CI in RRT patients, thought the underlying causes seem to be complex [ 7–9 ]. There is a limited number of papers describing patterns of cognitive dysfunction in patients with CKD [ 3–5 , 10–12 ] and verbal fluency, memory, processing speed and attention have been reported to be most affected [ 3–5 , 13 , 14 ]. We posited that selective impairment of certain cognitive domains may occur in CKD patients with no apparent general cognitive issues.…”

Cognitive Impairment and Anxiety Are Prevalent in Kidney Transplant Recipients

“…Kidney transplantation (KT) is the treatment of choice for most patients with end-stage kidney disease to increase survival and quality of life [ 1 ]. Cognitive impairment (CI) is common in hemodialysis and peritoneal dialysis patients [ 2 , 3 ] and may also be detected in kidney transplant candidates [ 4 ]. CI prior to KT is associated with a lower likelihood of being listed for transplant and with a longer waitlist for transplantation [ 5 ].…”