Vitamin D Status Is an Independent Risk Factor for Global Cognitive Impairment in Peritoneal Dialysis Patients

Liu, Guiling; Pi, Hai-Chen; Hao, Li; Li, Dandan; Wu, Yuangang; Dong, Jie

doi:10.1371/journal.pone.0143782

Cited by 27 publications

(21 citation statements)

References 40 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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“…10,11 Observational studies have found independent associations between the presence of 25-hydroxyvitamin D deficiency, hyperparathyroidism, untreated anaemia, cardiovascular disease and prior stroke with dialysis-associated MCI. [12][13][14][15][16] Associations with the parathyroid axis have been reinforced with postoperative improvements in cognitive and memory domains observed in patients undergoing surgery for secondary hyperparathyroidism, 17 though only in small studies. It is hoped that prospective longitudinal studies such as the Brain IN Kidney disease (BRINK) cohort may provide deeper mechanistic insights in the future.…”

Section: Diagnostic Definitions and Pathophysiologymentioning

confidence: 99%

Known unknowns: Examining the burden of neurocognitive impairment in the end‐stage renal failure population

et al. 2018

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The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains which are associated with hospitalisation, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggests that dialysis patients manifest NCI at rates 3-5 fold higher than the general population with executive function the most This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/nep.13223This article is protected by copyright. All rights reserved.Accepted Article commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates. Despite the absence of evidence based cost-effective therapies for NCI, detecting it in this population creates opportunity to proactively personalise care through education, supported decision making and targeted communication strategies to cover specific areas of deficit and help define goals of care. This review discusses NCI in the dialysis setting, including developments in the definition of neurocognitive impairment, dialysis-specific epidemiology across modalities, screening strategies and opportunities for dialysis providers in this space.

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“…In addition, in PD patients, low 25VD was found to be the independent factor for global cognitive impairment due to the antioxidant and neuroprotective role of 1,25VD. This is of crucial importance, as PD is a home-based renal replacement therapy that needs adequate cognition and self-monitoring [75].…”

Section: Muscle Health and Cognitive Functionmentioning

confidence: 99%

Vitamin D Deficiency in Renal Disease

Filipov¹,

Dimitrov²

2020

Vitamin D Deficiency

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Vitamin D deficiency is highly prevalent in patients with renal disease. The abnormal vitamin D (VD) metabolism in chronic kidney disease (CKD) is a key factor for developing CKD-related mineral bone disease (CKD-MBD), which directly influences the survival of the CKD patients. The importance of VD is perhaps of greater value due to its pleiotropic effects that span beyond calcium-phosphorus metabolism (cancer protection, diabetes prevention, and renal protection). The aim of our chapter is to depict the clinical implications of VD deficiency in the setting of CKD, including VD pleiotropy in renal disease, and to propose the most adequate treatment suggested in the literature. Keywords: vitamin D deficiency, chronic kidney disease, mineral bone disease, vitamin D pleiotropy, vitamin D supplementationVitamin D Deficiency 2 the ratio between free and total 25VD remained unchained; therefore, total 25VD is the indicator of VD status in CKD [3].Generally, 25VD level has reverse association with parathyroid hormone (PTH) levels. In addition, higher 25VD is associated with higher calcium intestinal reabsorption. However, at 25VD ≥ 75 nmol/l, no reduction in PTH levels and no increase in calcium intestinal reabsorption occurs [4, 5]. Therefore, 25VD ≥ 75 nmol/l is regarded as a cut-off value for vitamin D sufficiency.No generally accepted definition for VD deficiency exists, as authors choose cut-off value either serum 25VD of 25 nmol/L [6] or serum 25VD of 50 nmol/L [7]. However, target levels of 75 nmol/L are recommended, taking into consideration the clinical importance of mild VD insufficiency (25VD between 50 and 74.9 nmol/L) [7,8].Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for more than 3 months, with implications for health [one of the following: estimated glomerular filtration rate (eGFR) less than 60 ml/ min/1.73 m 2 ,presence of proteinuria, structural abnormalities of the kidney detected on imaging, pathological findings detected on kidney biopsy, urine sediment pathology, electrolyte abnormalities due to tubular disorders, history of kidney transplantation] [9]. CKD patients are at increased risk for VD deficiency; therefore, they require VD screening [7]. Vitamin D metabolism in health and renal disease VD metabolism in healthy subjectsVD is synthesized predominantly endogenously (approx. to 90% of the total VD in human body). In the skin, the ultraviolet light transforms 7-dehydroxycholesterol (provitamin D) to pre-vitamin D, which under the influence of body temperature spontaneously isomerizes to cholecalciferol (vitamin D3). Approximately, 10% of total body VD is taken orally (vitamin D2, ergocalciferol, and cholecalciferol). VD is transported via VD-binding protein to the liver, where it is hydroxylated to 25VD. The next step in VD activation is hydroxylation of 25VD by the enzyme 1α-hydroxylase (CYP27B1) to 1,25VD, which is the active VD metabolite. The process occurs predominantly in the renal tubules. In addition, non-renal CYP27B1 was detected...

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Vitamin D Status Is an Independent Risk Factor for Global Cognitive Impairment in Peritoneal Dialysis Patients

Cited by 27 publications

References 40 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

Known unknowns: Examining the burden of neurocognitive impairment in the end‐stage renal failure population

Vitamin D Deficiency in Renal Disease

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