Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis

O’Lone, Emma; Connors, Michael H.; Masson, Philip; Wu, Sunny Z.; Kelly, Patrick J.; Gillespie, David; Parker, Daniel C.; Whiteley, William; Strippoli, Giovanni F.M.; Palmer, Suetonia C.; Craig, Jonathan C.; Webster, Angela C

doi:10.1053/j.ajkd.2015.12.028

Cited by 211 publications

(219 citation statements)

References 57 publications

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“…It is also possible that these black and Hispanic patients on hemodialysis are now receiving routine medical care, which allows for the diagnosis with dementia after hemodialysis initiation, because dementia is often undiagnosed in this population. This work builds on the previous findings about prevalent dementia among patients on hemodialysis (14,15,36,37) and extends these findings to incident dementia among older patients with ESKD initiating hemodialysis.…”

Section: Discussionsupporting

confidence: 59%

“…These older patients on hemodialysis are likely at high risk of developing and being diagnosed with dementia and Alzheimer's disease given that they have worse cognitive function than the general population (14,15), have a greater burden of white matter disease and cerebral atrophy (16), experience significant decline in cognitive function while undergoing hemodialysis (17), and have a high burden of cognitive impairment even at younger ages (17)(18)(19). Executive function is the domain of cognition most affected by hemodialysis within the first 2 years after initiation (18), and impairments in executive function are early signs of dementia and Alzheimer's disease (20,21).…”

Section: Introductionmentioning

confidence: 99%

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Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

McAdams‐DeMarco

Daubresse²,

Bae

et al. 2018

CJASN

102

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Background and objectives Older patients with ESKD experience rapid declines in executive function after initiating hemodialysis; these impairments might lead to high rates of dementia and Alzheimer's disease in this population. We estimated incidence, risk factors, and sequelae of diagnosis with dementia and Alzheimer's disease among older patients with ESKD initiating hemodialysis.Design, setting, participants, & measurements We studied 356,668 older (age $66 years old) patients on hemodialysis (January 1, 2001 to December 31, 2013) from national registry data (US Renal Data System) linked to Medicare. We estimated the risk (cumulative incidence) of diagnosis of dementia and Alzheimer's disease and studied factors associated with these disorders using competing risks models to account for death, change in dialysis modality, and kidney transplant. We estimated the risk of subsequent mortality using Cox proportional hazards models.Results The 1-and 5-year risks of diagnosed dementia accounting for competing risks were 4.6% and 16% for women, respectively, and 3.7% and 13% for men, respectively. The corresponding Alzheimer's disease diagnosis risks were 0.6% and 2.6% for women, respectively, and 0.4% and 2.0% for men, respectively. The strongest independent risk factors for diagnosis of dementia and Alzheimer's disease were age $86 years old (dementia: hazard ratio, 2.11; 95% confidence interval, 2.04 to 2.18; Alzheimer's disease: hazard ratio, 2.11; 95% confidence interval, 1.97 to 2.25), black race (dementia: hazard ratio, 1.70; 95% confidence interval, 1.67 to 1.73; Alzheimer's disease: hazard ratio, 1.78; 95% confidence interval, 1.71 to 1.85), women (dementia: hazard ratio, 1.10; 95% confidence interval, 1.08 to 1.12; Alzheimer's disease: hazard ratio, 1.12; 95% confidence interval, 1.08 to 1.16), and institutionalization (dementia: hazard ratio, 1.36; 95% confidence interval, 1.33 to 1.39; Alzheimer's disease: hazard ratio, 1.10; 95% confidence interval, 1.05 to 1.15). Older patients on hemodialysis with a diagnosis of dementia were at 2.14-fold (95% confidence interval, 2.07 to 2.22) higher risk of subsequent mortality; those with a diagnosis of Alzheimer's disease were at 2.01-fold (95% confidence interval, 1.89 to 2.15) higher mortality risk.Conclusions Older patients on hemodialysis are at substantial risk of diagnosis with dementia and Alzheimer's disease, and carrying these diagnoses is associated with a twofold higher mortality.

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Section: Discussionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

McAdams‐DeMarco

Daubresse²,

Bae

et al. 2018

CJASN

102

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“…CI is 3 times more common in haemodialysis patients than in age-matched general population with as many as 70% of haemodialysis patients over the age of 55 with moderate to severe CI [4-6]. A recent meta-analysis showed that patients treated with haemodialysis have more CI than the general population with orientation, attention, memory and executive function being the most affected [7]. Cognitive function drops significantly after the start of haemodialysis and progresses in a stepwise fashion.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Function Declines Significantly during Haemodialysis in a Majority of Patients: A Call for Further Research

et al. 2018

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Introduction: Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. Methods: All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. Results: Eight-two patients completed both tests – median age 73 (52–91) years, 59% male, dialysis vintage 41 (3–88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. Conclusion: Cognitive function declines over a haemodialysis session and this has significant clinical implications over health literacy, self-management and tasks like driving. More research is needed to find the cause for this decline in cognition.

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“…The differences in inclusion and exclusion criteria, depending on the purpose of the study, may also explain the variable prevalence. While the prevalence of cognitive impairment in people on dialysis is not clear, 2 systematic reviews found that people with ESKD with or without dialysis consistently had lower scores, indicating a high likelihood of cognitive impairment [5,64]. …”

Section: Discussionmentioning

confidence: 99%

“…The reported prevalence of cognitive impairment among patients with ESKD, as assessed using neuropsychological tests, varies from 16 to 38% [4]. In a recent systematic review, people treated with haemodialysis were found to have more cognitive impairment than the general population in most cognitive domains [5]. …”

Section: Introductionmentioning

confidence: 99%

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

San

Hiremagalur

Muircroft

et al. 2017

Dement Geriatr Cogn Disord

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Background: Cognitive impairment in end-stage kidney disease patients on dialysis is increasingly common. This study aimed to review the practice of screening and to evaluate the evidence on cognitive impairment prevalence in this population. Methods: This scoping review of studies summarises the evidence on cognitive impairment in dialysis populations. The search included the Medline, CINAHL, Embase, PsycINFO, PubMed, and Cochrane Library databases for English-language articles published between 2000 and 2015. A total of 46 articles were reviewed. Results: The studies were of prospective observational design, with the majority conducted in the haemodialysis population. The reported prevalence of cognitive impairment ranged from 6.6 to 51%. Three screening tools were consistently used. Conclusion: While cognitive impairment is recognised in the dialysis population, there is paucity of screening data. The design of prospective comparisons ideally includes established screening instruments, particularly the Montreal Cognitive Assessment, to determine the optimal results for this population. Translation of established screening tools to increase the inclusion of people from other cultural and language groups is required. Regular screening can enhance the timing to introduce home-based care support and advance care planning discussions.

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Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis

Cited by 211 publications

References 57 publications

Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

Cognitive Function Declines Significantly during Haemodialysis in a Majority of Patients: A Call for Further Research

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

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