Cognitive Impairment and its Correlates in Chronic Kidney Disease Patients Undergoing Haemodialysis

Abstract

BACKGROUND Cognitive Impairment (CI) has been found to be quite common amongst patients with Chronic Kidney Disease (CKD) undergoing haemodialysis (HD). The presence of these deficits could affect patient’s adherence to diet regimens, treatment and also reduce their Quality of Life. The presence of depression in such patients can further lead to CI. We wanted to assess the prevalence of CI in CKD patients undergoing haemodialysis, socio-demographic and patient related variables affecting CI, and also the relationship between depression and cognition. METHODS Fifty patients undergoing haemodialysis from two dialysis units were assessed. The Montreal Cognitive Assessment (MoCA) scale and Patient Health Questionnaire-9 (PHQ-9) were administered to patients. Descriptive analysis was done for the socio-demographic and clinical variables. Chi square test was used to find the association between the categorical data. Kruskal-Wallis test was used to determine the association between categorical and quantitative variables. RESULTS Mean age of patient was 50.32 (±12.4) years. Mean duration of dialysis was 18.8 (±15.11) months. The prevalence of depression in the patients was 42%. Cognitive impairment was present in 44% of the patients. There was a significant relationship between education level and recall (χ2=31.7, df=12, p=.002) as well as orientation (χ2=29.78, df=8, p=.000) domains of cognition. Also, there was a significant relationship between socio-economic status and global cognition score (χ2=81.13, df=48, p=.002). There was a negative correlation between duration of dialysis and cognition. Significant relationships were found between depression and various cognitive domains. CONCLUSIONS The prevalence of CI in haemodialysis patients is high. It is also affected by factors such as education level, socio-economic status, duration of dialysis and presence of depression. Insight into CI is essential for its early identification during the course of illness, so that patient precise treatment decisions can be made.

Assessment of cognitive impairment and related risk factors in hemodialysis patients

“…Lower levels of education are associated with cognitive impairment in our study, as reported by others [32,35,36]. This may be explained by the association of lower education levels with poor functional and cognitive reserves.…”

“…To evaluate the frequency of depression and its effect on cognitive performance, the Geriatric depression scale (GDS) was adopted, and in our study depression was found to be significantly associated with cognitive impairment. Other studies have also found similar decline in cognition with the presence of depression [32,38,39]. This can be explained by the effects of symptoms of depression on domains of executive functioning and processing speed, in keeping with previous studies [39].…”

“…Moreover, anemia, secondary hyperparathyroidism, dialysis disequilibrium and uremic toxins have also been reported as causes of cognitive impairment in CKD [31], as well as dialysis duration [32]. Dialysis vintage (months) and duration of the dialysis session (hours) showed no association with cognitive performance in our patients.…”

Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study

“…20 Those chronic kidney disease patients with cognitive impairment have an increased risk of death, poor quality of life, difficulty in adhering to medications, and worse quality of emotional well-being. [21][22][23][24][25][26][27][28][29] It is a major cause of morbidity and a determinant of the quality of life in the elderly chronic kidney disease patients. 30,31 Among hemodialysis patients it is also associated with an approximately two-fold increased risk of both mortality and dialysis withdrawal.…”

A population‐based study of the association between hemodialysis and cognitive impairment

“…Kurella, Chertow, Luan, and Yaffe (2004) reported that the incidence of cognitive impairment is approximately 2 to 7 times higher among ESRD patients than among other patients (Kurella et al, 2004). All of the above studies emphasized the importance of research into the relationship between ESRD and cognitive impairment (Cerasola, Nardi, Palermo, Mulè, & Cottone, 2011; Fukunishi et al, 2002; Joseph, Bhandari, & Dutta, 2019; Owolabi et al, 2016).…”