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Cognitive impairment and 7-year mortality in dialysis patients

Cognitive impairment and 7-year mortality in dialysis patients
Cognitive impairment and 7-year mortality in dialysis patients
Background: although dementia has predicted mortality in large dialysis cohorts, little is known about the relationship between less pronounced cognitive deficits and mortality in patients with end-stage renal disease. This study assessed whether cognitiveimpairment without dementia was an independent predictor of 7-year survival in dialysispatients after controlling for other risk factors.

Study design: prospective single-cohort study.

Setting & participants: 145 prevalent dialysispatients from 2 units in London, UK, were followed up for 64.3 ± 27.4 months and censored at the time of change to a different treatment.

Predictors: cognitiveimpairment, defined as performance 1 standard deviation less than normative values on 2 or more cognitive tests within a neurocognitive battery assessing attention/concentration, memory, and psychomotor function domains. Depression, quality-of-life, and clinical measures also were obtained.

Outcomes & measurements: all-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical and psychological measures and cognitiveimpairment to mortality.

Results: 98 (67.6%) patients were cognitively impaired at baseline. At follow-up, 56 (38.6%) patients had died, 29 of cardiac causes. Unadjusted Kaplan-Meier analysis showed higher mortality in cognitively impaired patients, in whom 7-year survival was 49% versus 83.2% in those with no cognitiveimpairment (P < 0.001). Mortality risk associated with cognitiveimpairment remained significant in adjusted analysis controlling for sociodemographic, clinical, and psychological factors (adjusted HR, 2.53; 95% CI, 1.03-6.22; P = 0.04).

Limitations: small sample size and number of events.

Conclusions: cognitiveimpairment is an independent predictor of mortality in dialysispatients. Although the implications of early recognition and treatment of cognitiveimpairment for clinical outcomes are unclear, these results suggest that patient management protocols should attempt to ensure prevention of cognitive decline in addition to managing coexisting medical conditions
cognition, mortality, dialysis, impairment
693-703
Griva, Konstadina
65764a3c-0bb4-4d44-a8eb-0296c4406b97
Stygall, Jan
6fa34a7a-824d-49d5-afd9-37e855c90071
Hankins, Matthew
ce4b7d68-3320-4af4-9dd7-3537a4b07219
Davenport, Andrew
c4c221ab-4152-4419-8a63-332a1c5c2e57
Harrison, Michael
d4173d6f-51f6-4ee1-a9be-5c185eeb4222
Newman, Stanton P.
f74e2dc5-69f7-4bcd-911f-0862ccb60356
Griva, Konstadina
65764a3c-0bb4-4d44-a8eb-0296c4406b97
Stygall, Jan
6fa34a7a-824d-49d5-afd9-37e855c90071
Hankins, Matthew
ce4b7d68-3320-4af4-9dd7-3537a4b07219
Davenport, Andrew
c4c221ab-4152-4419-8a63-332a1c5c2e57
Harrison, Michael
d4173d6f-51f6-4ee1-a9be-5c185eeb4222
Newman, Stanton P.
f74e2dc5-69f7-4bcd-911f-0862ccb60356

Griva, Konstadina, Stygall, Jan, Hankins, Matthew, Davenport, Andrew, Harrison, Michael and Newman, Stanton P. (2010) Cognitive impairment and 7-year mortality in dialysis patients. American Journal of Kidney Diseases, 56 (4), 693-703. (doi:10.1053/j.ajkd.2010.07.003). (PMID:20800327)

Record type: Article

Abstract

Background: although dementia has predicted mortality in large dialysis cohorts, little is known about the relationship between less pronounced cognitive deficits and mortality in patients with end-stage renal disease. This study assessed whether cognitiveimpairment without dementia was an independent predictor of 7-year survival in dialysispatients after controlling for other risk factors.

Study design: prospective single-cohort study.

Setting & participants: 145 prevalent dialysispatients from 2 units in London, UK, were followed up for 64.3 ± 27.4 months and censored at the time of change to a different treatment.

Predictors: cognitiveimpairment, defined as performance 1 standard deviation less than normative values on 2 or more cognitive tests within a neurocognitive battery assessing attention/concentration, memory, and psychomotor function domains. Depression, quality-of-life, and clinical measures also were obtained.

Outcomes & measurements: all-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical and psychological measures and cognitiveimpairment to mortality.

Results: 98 (67.6%) patients were cognitively impaired at baseline. At follow-up, 56 (38.6%) patients had died, 29 of cardiac causes. Unadjusted Kaplan-Meier analysis showed higher mortality in cognitively impaired patients, in whom 7-year survival was 49% versus 83.2% in those with no cognitiveimpairment (P < 0.001). Mortality risk associated with cognitiveimpairment remained significant in adjusted analysis controlling for sociodemographic, clinical, and psychological factors (adjusted HR, 2.53; 95% CI, 1.03-6.22; P = 0.04).

Limitations: small sample size and number of events.

Conclusions: cognitiveimpairment is an independent predictor of mortality in dialysispatients. Although the implications of early recognition and treatment of cognitiveimpairment for clinical outcomes are unclear, these results suggest that patient management protocols should attempt to ensure prevention of cognitive decline in addition to managing coexisting medical conditions

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More information

Published date: October 2010
Keywords: cognition, mortality, dialysis, impairment
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 187289
URI: http://eprints.soton.ac.uk/id/eprint/187289
PURE UUID: 121bba26-2f64-42f4-a8ae-78564197561a

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Date deposited: 16 May 2011 15:59
Last modified: 14 Mar 2024 03:23

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Contributors

Author: Konstadina Griva
Author: Jan Stygall
Author: Matthew Hankins
Author: Andrew Davenport
Author: Michael Harrison
Author: Stanton P. Newman

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