A Study of Executive Function in Patients with Chronic Kidney Disease before and after a Single Session of Hemodialysis

Murthy, Vasantmeghna S; Shukla, Vedant S.

doi:10.1055/s-0040-1703961

Cited by 5 publications

(5 citation statements)

References 28 publications

(26 reference statements)

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“…17 Among CKD patients, executive function is a particularly vulnerable cognitive domain, with significant deficits observed even in hemodialysis recipients. Research by Kurella Tamura et al 18 in 2017 and corroborated by Murthy and Shukla 19 in 2020 underscores the vulnerability of executive function in CKD patients.…”

Section: Discussionmentioning

confidence: 93%

Indoxyl Sulphate Levels and Its Relation with Executive Function in Routine Hemodialysis Patients

Syafrita,

Susanti,

Indra

et al. 2023

Glob Med Health Commun

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Executive function is a crucial cognitive domain that can be adversely affected by various toxic substances, including the uremic toxin indoxyl sulfate. Although it's known that indoxyl sulfate has harmful effects on intra or extra-kidney organs, its impact on executive function remains unclear. This study aimed to evaluate indoxyl sulfate levels in patients with chronic kidney disease (CKD) undergoing hemodialysis and to understand its correlation with executive function impairments. This observational cross-sectional study was conducted at the Dr. M. Djamil General Hospital Padang Hemodialysis Unit from March to July 2022; 60 patients undergoing hemodialysis and 20 healthy controls participated. Executive function was assessed using the Trail Making Test B (TMT-B). Indoxyl sulfate levels were quantified using an ELISA assay with the Assay Genie kit. The Mann-Whitney test set statistical significance at a p<0.05. The average age of the subjects was 51.4±11.4 years, with 53.3% being male. The mean indoxyl sulfate levels were considerably higher in the CKD group (118.79 ng/mL, range: 11–1,709 ng/mL) compared to the control group (6.028±1.829 ng/mL), with a significant difference (p<0.001). Impaired executive function was observed in 75% of the CKD patients. The average indoxyl sulfate level was 165.12 ng/mL (range: 29–1709 ng/mL) in the impaired executive function group and 71.22 ng/mL (range: 11–333 ng/mL) in the group with normal executive function, indicating a significant difference (p=0.013). Patients with CKD undergoing hemodialysis exhibit elevated serum indoxyl sulfate levels compared to healthy individuals. Moreover, CKD patients with impaired executive function have notably higher indoxyl sulfate levels than those with normal executive function. Further research is needed to elucidate the mechanistic links between indoxyl sulfate and cognitive impairments.

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Section: Discussionmentioning

confidence: 93%

Indoxyl Sulphate Levels and Its Relation with Executive Function in Routine Hemodialysis Patients

Syafrita,

Susanti,

Indra

et al. 2023

Glob Med Health Commun

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“…Visuospatial and executive dysfunction are being increasingly reported in patients with kidney disease. 10,12,13 The aim of this study was to extend our preliminary findings suggesting that robotic technology can quantify subtle neurocognitive impairments in patients with CKD 10 and after a single episode of AKI. 11 Specifically, we wanted to assess the association between degree of kidney dysfunction and quantitative metrics of neurocognitive performance.…”

Section: Discussionmentioning

confidence: 99%

“… 10 Impairments in these areas are corroborated by more recent literature supporting the decline of visuomotor and executive function early on in patients with kidney disease. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

“…10 Impairments in these areas are corroborated by more recent literature supporting the decline of visuomotor and executive function early on in patients with kidney disease. 12,13 Although neurocognitive impairment in CKD and kidney failure is well established, studies examining and comparing objective and quantifiable neurocognitive impairments across the full spectrum of kidney disease are lacking. Furthermore, given that AKI has also been recently associated with neurocognitive impairment, it is important to contextualize the degree of this impairment with the deficits observed in patients with CKD and kidney failure, as these clinical populations are commonly seen and assessed in nephrology clinics.…”

Section: Introductionmentioning

confidence: 99%

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Visuospatial and Executive Dysfunction in Patients With Acute Kidney Injury, Chronic Kidney Disease, and Kidney Failure: A Multilevel Modeling Analysis

Jawa

Vanderlinden

Scott

et al. 2022

Can J Kidney Health Dis

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Background: Neurocognitive impairment is a common finding across the spectrum of kidney disease and carries important consequences for quality of life. We previously demonstrated that robotic technology can identify neurocognitive impairments not readily detectable by traditional testing in patients with acute kidney injury (AKI) and chronic kidney disease (CKD). Objective: The present study aimed to assess whether these quantifiable deficits in neurocognition differ based on a diagnosis of AKI, CKD, or kidney failure. Design: This was a cross-sectional analysis of participants previously enrolled in an observational study. Setting: Patients were enrolled at a tertiary academic hospital, Kingston Health Sciences Centre, Kingston, ON, Canada. Patients: Adults with AKI, CKD, or kidney failure. Measurements: Each participant underwent robotic neurocognitive assessment using the Kinarm: an interactive robotic device that uses a series of behavioral tasks involving movement of the upper limbs to precisely quantify neurocognitive impairment across a variety of neurocognitive domains. Methods: Multilevel modeling was used to determine the effect of Kinarm task type, kidney diagnostic group (AKI vs CKD vs kidney failure), and the interaction between the two, on neurocognitive performance. Results: A total of 104 participants within 1 year of an AKI event or with CKD category G3-5 were enrolled. We found that across all of the kidney diagnostic groups, participants performed worst on the Kinarm tasks of Reverse Visually Guided Reaching ( b = 0.64 [95% confidence interval = 0.42, 0.85]), Visually Guided Reaching ( b = 0.28 [0.07, 0.49]), and Trail Making ( b = 0.50 [0.28, 0.72]), relative to all other tasks. There were no significant differences in average performance across tasks based on kidney diagnostic group. However, diagnostic group and neurocognitive task type interacted to determine performance, such that patients with AKI performed worse than those with either CKD or kidney failure on the Reverse Visually Guided Reaching task. Limitations: Kinarm assessment was performed at a single time point, and the sample size itself was small, which may lead to the risk of a false-positive association despite the use of multilevel modeling. Our sample size also did not permit inclusion of the underlying etiology of kidney impairment as a covariate in our analyses, which may have also influenced neurocognitive function. Conclusions: In this study that utilized the Kinarm to assess neurocognitive function, patients with AKI demonstrated significantly worse neurocognitive functioning than patients with CKD or kidney failure on a task measuring executive function and visuomotor control.

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“…In clinical practice, these 3 factors often exhibit a causative relationship. Lower cognitive abilities frequently result in reduced adherence, [ 23 ] which in turn further diminishes the quality of life. Moreover, decreased adherence can exacerbate disease progression, intensify cerebrovascular changes, peritonitis and lead to further cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

Exploring the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Wu,

Yu,

et al. 2023

Medicine

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The aim of this study is to investigate the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). A cross-sectional study was conducted among patients with CAPD at the Department of Nephrology, Lianshui People’s Hospital from October 2021 to May 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and the End-Stage Renal Disease Adherence Questionnaire was used to evaluate treatment compliance. Quality of life was assessed using the SF-36 questionnaire. Scores from all the questionnaires and demographic data were recorded. A total of 98 patients were enrolled, and the prevalence of cognitive impairment among CAPD patients was 69.39% (MoCA score < 26). Patients were divided into 2 groups: one group with normal cognitive function (MoCA score ≥ 26) and the other with cognitive impairments. There were statistically significant differences in age, dialysis age, education, urea clearance index, history of high blood pressure, and diabetes between the 2 groups (all P < .05). Patients with cognitive impairments had lower compliance levels in terms of diet fluid restriction, medication therapeutic regimens, and dialysis regimen (all P < .05). Patients with cognitive impairments also had lower quality of life scores in the dimensions of physical function, general health, social function, emotional function, and mental health (all P < .05). Cognitive impairment appears to be common among CAPD patients and may adversely affect both their treatment adherence and overall quality of life. A more comprehensive understanding of the underlying mechanisms necessitates further study.

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A Study of Executive Function in Patients with Chronic Kidney Disease before and after a Single Session of Hemodialysis

Cited by 5 publications

References 28 publications

Indoxyl Sulphate Levels and Its Relation with Executive Function in Routine Hemodialysis Patients

Indoxyl Sulphate Levels and Its Relation with Executive Function in Routine Hemodialysis Patients

Visuospatial and Executive Dysfunction in Patients With Acute Kidney Injury, Chronic Kidney Disease, and Kidney Failure: A Multilevel Modeling Analysis

Exploring the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD)

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