TY - JOUR
T1 - Cognitive Impairment in Non–Dialysis-Dependent CKD and the Transition to Dialysis
T2 - Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
AU - CRIC Study Investigators
AU - Harhay, Meera N.
AU - Xie, Dawei
AU - Zhang, Xiaoming
AU - Hsu, Chi yuan
AU - Vittinghoff, Eric
AU - Go, Alan S.
AU - Sozio, Stephen M.
AU - Blumenthal, Jacob
AU - Seliger, Stephen
AU - Chen, Jing
AU - Deo, Rajat
AU - Dobre, Mirela
AU - Akkina, Sanjeev
AU - Reese, Peter P.
AU - Lash, James P.
AU - Yaffe, Kristine
AU - Tamura, Manjula Kurella
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - He, Jiang
AU - Kusek, John W.
AU - Rao, Panduranga
AU - Rahman, Mahboob
N1 - Publisher Copyright:
© 2018 National Kidney Foundation, Inc.
PY - 2018/10
Y1 - 2018/10
N2 - Background: Advanced chronic kidney disease is associated with elevated risk for cognitive impairment. However, it is not known whether and how cognitive impairment is associated with planning and preparation for end-stage renal disease. Study Design: Retrospective observational study. Setting & Participants: 630 adults participating in the CRIC (Chronic Renal Insufficiency Cohort) Study who had cognitive assessments in late-stage CKD, defined as estimated glome-rular filtration rate ≤ 20 mL/min/1.73 m2, and subsequently initiated maintenance dialysis therapy. Predictor: Predialysis cognitive impairment, defined as a score on the Modified Mini-Mental State Examination lower than previously derived age-based threshold scores. Covariates included age, race/ethnicity, educational attainment, comorbid conditions, and health literacy. Outcomes: Peritoneal dialysis (PD) as first dialysis modality, preemptive permanent access placement, venous catheter avoidance at dialysis therapy initiation, and preemptive wait-listing for a kidney transplant. Measurements: Multivariable-adjusted logistic regression. Results: Predialysis cognitive impairment was present in 117 (19%) participants. PD was the first dialysis modality among 16% of participants (n = 100), 75% had preemptive access placed (n = 473), 45% avoided using a venous catheter at dialysis therapy initiation (n = 279), and 20% were preemptively wait-listed (n = 126). Predialysis cognitive impairment was independently associated with 78% lower odds of PD as the first dialysis modality (adjusted OR [aOR], 0.22; 95% CI, 0.06-0.74; P = 0.02) and 42% lower odds of venous catheter avoidance at dialysis therapy initiation (aOR, 0.58; 95% CI, 0.34-0.98; P = 0.04). Predialysis cognitive impairment was not independently associated with preemptive permanent access placement or wait-listing. Limitations: Potential unmeasured confounders; single measure of cognitive function. Conclusions: Predialysis cognitive impairment is associated with a lower likelihood of PD as a first dialysis modality and of venous catheter avoidance at dialysis therapy initiation. Future studies may consider addressing cognitive function when testing strategies to improve patient transitions to dialysis therapy.
AB - Background: Advanced chronic kidney disease is associated with elevated risk for cognitive impairment. However, it is not known whether and how cognitive impairment is associated with planning and preparation for end-stage renal disease. Study Design: Retrospective observational study. Setting & Participants: 630 adults participating in the CRIC (Chronic Renal Insufficiency Cohort) Study who had cognitive assessments in late-stage CKD, defined as estimated glome-rular filtration rate ≤ 20 mL/min/1.73 m2, and subsequently initiated maintenance dialysis therapy. Predictor: Predialysis cognitive impairment, defined as a score on the Modified Mini-Mental State Examination lower than previously derived age-based threshold scores. Covariates included age, race/ethnicity, educational attainment, comorbid conditions, and health literacy. Outcomes: Peritoneal dialysis (PD) as first dialysis modality, preemptive permanent access placement, venous catheter avoidance at dialysis therapy initiation, and preemptive wait-listing for a kidney transplant. Measurements: Multivariable-adjusted logistic regression. Results: Predialysis cognitive impairment was present in 117 (19%) participants. PD was the first dialysis modality among 16% of participants (n = 100), 75% had preemptive access placed (n = 473), 45% avoided using a venous catheter at dialysis therapy initiation (n = 279), and 20% were preemptively wait-listed (n = 126). Predialysis cognitive impairment was independently associated with 78% lower odds of PD as the first dialysis modality (adjusted OR [aOR], 0.22; 95% CI, 0.06-0.74; P = 0.02) and 42% lower odds of venous catheter avoidance at dialysis therapy initiation (aOR, 0.58; 95% CI, 0.34-0.98; P = 0.04). Predialysis cognitive impairment was not independently associated with preemptive permanent access placement or wait-listing. Limitations: Potential unmeasured confounders; single measure of cognitive function. Conclusions: Predialysis cognitive impairment is associated with a lower likelihood of PD as a first dialysis modality and of venous catheter avoidance at dialysis therapy initiation. Future studies may consider addressing cognitive function when testing strategies to improve patient transitions to dialysis therapy.
KW - CKD to ESRD transition
KW - Chronic kidney diseases (CKDs)
KW - central venous catheter (CVC)
KW - cognitive impairment
KW - dementia
KW - dialysis access
KW - dialysis modality
KW - end-stage renal disease (ESRD)
KW - executive function
KW - incident ESRD
KW - memory
KW - peritoneal dialysis (PD)
KW - transplant waitlisting
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U2 - 10.1053/j.ajkd.2018.02.361
DO - 10.1053/j.ajkd.2018.02.361
M3 - Article
C2 - 29728316
AN - SCOPUS:85046793888
SN - 0272-6386
VL - 72
SP - 499
EP - 508
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -