Factors Affecting Cognitive Impairment in Chronic Kidney Disease Patients
DOI:
https://doi.org/10.21649/akemu.v30i3.5612Keywords:
Cognitive impairment, Chronic Kidney disease, Mini Mental State Examination, AnaemiaAbstract
Background: Cognitive impairment (CI) is frequently observed in patients with chronic kidney disease (CKD). There are many factors associated with CI in CKD patients in international studies but no study has been done previously in Pakistan on this important issue.
Objective: The objective of this study was to determine factors affecting CI in CKD patients
Methods: This observational study was carried out in Nephrology Department of Mayo Hospital, Lahore (January 2023 to March 2023). All CKD patients, regardless of cause, were included while patients on renal replacement therapy (RRT) were excluded. The Mini-Mental State Examination (MMSE) tool was employed to evaluate cognitive function.
Results: A total of 100 patients were enrolled. The average age of the patients was 50.44±12.58 years, with diabetes mellitus (DM) being the leading cause of CKD in 53(53.0%) patients. CI was identified in 61(61.0%) patients while mild and moderate CI was found in 34 (34%) and 27 (27 %) respectively. Female gender (RR=1.40, 95%CI=1.01-193, p=0.042), low estimated glomerular filtration rate (eGFR) (RR=1.92, 95% CI=1.27-2.91, p=0.002), anemia (RR=1.23, 95% CI=1.01-1.50, p=0.003) and lower educational qualifications (RR= 3.39, 95% CI=1.65-6.94, p=<0.001) were found significant factors of CI. Increasing age was associated with increased CI severity (r=-0.110, p=0.278) while eGFR has positive correlation with CI score (r=0.271,p=0.006) .
Conclusion: CI was frequently prevalent among patients with CKD. Female gender, low eGFR, anemia and low level of education were independent predictors of CI in CKD patients. Advancing age has negative correlation while GFR has positive correlation with CI score.
References
: Morley JE. An Overview of Cognitive Impairment. Clin Geriatr Med. 2018;34(4):505-513. doi: 10.1016/j.cger.2018.06.003.
Xie Z, Tong S, Chu X, Feng T, Geng M. Chronic Kidney Disease and Cognitive Impairment: The Kidney-Brain Axis. Kidney Dis (Basel). 2022;8(4):275-285. doi: 10.1159/000524475.
Hobson P, Lewis A, Nair H, Wong S, Kumwenda M. How common are neurocognitive disorders in patients with chronic kidney disease and diabetes? Results from a cross-sectional study in a community cohort of patients in North Wales, UK. BMJ Open. 2018;8(12):e023520. doi: 10.1136/bmjopen-2018-023520.
Lu R, Xu C, Li Y, Yu L, Shao X, Xie K,et al.The Incidence Prognosis and Risk Factors of Cognitive Impairment in Maintenance Haemodialysis Patients. Blood Purif. 2019;47(1-3):101-108. doi: 10.1159/000493524.
Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis.2008;52(2):227-234.doi: 10.1053/j.ajkd.2008.05.004.
Drew DA, Weiner DE, Sarnak MJ. Cognitive Impairment in CKD: Pathophysiology, Management, and Prevention. Am J Kidney Dis. 2019;74(6):782-790. doi: 10.1053/j.ajkd.2019.05.017.
Bronass UG, Puzantian H, Hannan M. Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. Biomed Res Int. 2017;27(2):63-69. Doi: 10.1155/2017/2726369.
Gela YY, Getu AA, Adane A, Ayal BM, Akalu Y, Ambelu A,et al. Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study. Neuropsychiatr Dis Treat. 2021;17(1):1483-1492. doi: 10.2147/NDT.S304543.
Lin YT, Wu PH, Liang SS, Mubanga M, Yang YH, Hsu YL,et al. Protein-bound uremic toxins are associated with cognitive function among patients undergoing maintenance hemodialysis. Sci Rep. 2019;9(1):20388. doi: 10.1038/s41598-019-57004-7.
Guo Y, Tian R, Ye P, Li X, Li G, Lu F, et al. Cognitive Domain Impairment and All-Cause Mortality in Older Patients Undergoing Hemodialysis. Front Endocrinol (Lausanne). 2022 ;13(1):828-862. doi: 10.3389/fendo.2022.828162.
Awan S, Shahbaz N, Akhta S W, Ahmad A, Iqba S, Ahmed S,et al. Validation Study of the Mini Mental State Examination in Urdu Language for Pakistani Population. The Open Neurology Journal.2015; 9(1): 53-58.
Stevens PE, Levin A.Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-30. doi: 10.7326/0003-4819-158-11-201306040-00007. PMID: 23732715.
Locatelli F, Nissenson AR, Barrett BJ, Walker RG, Wheeler DC, Eckardt KU, et al. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2008;74(10):1237-40. doi: 10.1038/ki.2008.299. Epub 2008 Jul 2. PMID: 18596731.
Aggarwal HK, Jain D, Bhavikatti A. Cognitive Dysfunction in Patients with Chronic Kidney Disease. Saudi J Kidney Dis Transpl. 2020;31(4):796-804. doi: 10.4103/1319-2442.292313.
Williams UE, Owolabi MO, Ogunniyi A, Ezunu EO. Prevalence and pattern of neurocognitive impairment in Nigerians with Chronic Kidney Disease. ISRN Neurol. 2013;2013:1–6.doi: 10.1155/2013/374890
Gela YY, Getu AA, Adane A, Ayal BM, Akalu Y, Ambelu A,et al. Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study. Neuropsychiatr Dis Treat. 2021;17(1):1483-1492.doi: 10.2147/NDT.S304543.
Khatri M, Ryan CM, Gao X, de Boer IH, Braffett BH, Molitch M,et al. CKD Associates with Cognitive Decline in Middle-Aged and Older Adults with Long-Standing Type 1 Diabetes. Kidney360. 2023;4(8):1058-1071. doi: 10.34067/KID.0000000000000178.
Chandra M, Rai CB, Kumari N, Sandhu VK, Chandra K, Krishna M,et al. Air Pollution and Cognitive Impairment across the Life Course in Humans: A Systematic Review with Specific Focus on Income Level of Study Area. Int J Environ Res Public Health. 2022;19(3):1405. doi: 10.3390/ijerph19031405.
Anees M, Barki H, Masood M, Mumtaz A, Kausar T. Depression in hemodialysis patients. Pak J Med Sci. 2008;24(4):560-5.
Six I, Flissi N, Lenglet G, Louvet L, Kamel S, Gallet M,et al.Uremic Toxins and Vascular Dysfunction. Toxins (Basel). 2020;12(6):404. doi: 10.3390/toxins12060404
Handing EP, Jiao Y, Aichele S. Age-Related Trajectories of General Fluid Cognition and Functional Decline in the Health and Retirement Study: A Bivariate Latent Growth Analysis. J Intell. 2023;11(4):65. doi: 10.3390/jintelligence11040065.
Hammad M, Fardoos S, Arif R, Khan AZ, Rasheed A. Factors Related to Anemia Prevalence Among Women of Childbearing Age in the Period of Global Pandemic. Cureus. 2023;15(5):e38491. doi: 10.7759/cureus.38491.
Kurella Tamura M, Vittinghoff E, Yang J, Go AS, Seliger SL, Kusek JW,et al. Anemia and risk for cognitive decline in Chronic Kidney Disease. BMC Nephrol. 2016 ;17(1):13. doi: 10.1186/s12882-016-0226-6.
Varghese SM, Joy N, John AM, George G, Chandy GM, Benjamin AI. Sweet Memories or Not? A Comparative Study on Cognitive Impairment in Diabetes Mellitus. Front Public Health.2022;10(1):822062.doi: 10.3389/fpubh.2022.822062.
Barzilay JI, Morgan TM, Murray AM, Bryan RN, Williamson JD, Schnall A,et al. Brain MRI Volume Findings in Diabetic Adults With Albuminuria:The ACCORD-MIND Study. J Gerontol A Biol Sci Med Sci. 2016;71(6):803-10.doi: 10.1093/gerona/glv187.
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