Cognitive Impairment in Chronic Kidney Disease

Kurella, Manjula; Chertow, Glenn M.; Luan, Jennifer; Yaffe, Kristine

doi:10.1111/j.1532-5415.2004.52508.x

Cited by 396 publications

(428 citation statements)

References 31 publications

Supporting

Mentioning

378

Contrasting

Unclassified

Order By: Relevance

“…In a study of CKD and hemodialysis patients by Kurella and colleagues, among 80 hemodialysis patients (mean age 61.2 years), 38 percent had severe impairment in executive function and 33 percent severe memory impairment (10). We found very similar results in our recent study of 338 hemodialysis subjects.…”

Section: Prevalence Of Cognitive Impairment In Hemodialysis Patientssupporting

confidence: 83%

“…Among Stage 3-4 CKD patients in Kurella's study above, 23 percent had severely impaired executive function and 28 percent scored poorly on delayed memory (10). Multiple studies report a cross-sectional, graded relation between eGFR level and cognitive function (10)(11)(12).…”

Section: Cognitive Impairment In Chronic Kidney Disease Patientsmentioning

confidence: 94%

“…Two recent studies describe the high prevalence of cognitive impairment in CKD and hemodialysis patients (2,10). In a study of CKD and hemodialysis patients by Kurella and colleagues, among 80 hemodialysis patients (mean age 61.2 years), 38 percent had severe impairment in executive function and 33 percent severe memory impairment (10).…”

Section: Prevalence Of Cognitive Impairment In Hemodialysis Patientsmentioning

confidence: 99%

“…Multiple studies report a cross-sectional, graded relation between eGFR level and cognitive function (10)(11)(12). In the Heart, Estrogen/Progesterone Study among menopausal women, each 10-mL/min/1.73 m2 decrement in eGFR corresponded to an approximately 15 percent to 25 percent increase in risk for cognitive dysfunction among individual cognitive domains (11).…”

Section: Cognitive Impairment In Chronic Kidney Disease Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

344

241

View full text Add to dashboard Cite

The heavy burden of cognitive impairment in hemodialysis and chronic kidney disease patients has only recently become recognized. Up to 70 percent of hemodialysis patients ages 55 years and older have moderate to severe chronic cognitive impairment, yet it is largely undiagnosed. Recent studies describe the strong graded relation between estimated glomerular filtration rate (eGFR) and cognitive function in CKD patients. The process of conventional hemodialysis may induce recurrent episodes of acute cerebral ischemia, which in turn may contribute to acute decline in cognitive function during dialysis. Thus the worst time to communicate with dialysis patients may be during the hemodialysis session. Both symptomatic and occult, subclinical ischemic cerebrovascular disease appear to play a large role in a proposed model of accelerated vascular cognitive impairment in these populations. Severe cognitive impairment or dementia among hemodialysis patients is associated with an approximately two-fold increased risk of both mortality and dialysis withdrawal. Pre-dialysis cognitive screening and adding dementia to the list of comorbidities on Form 2728 would provide critical information regarding the benefit versus risks of receiving dialysis. It could also improve quality of care and outcomes by raising clinician's awareness of the potential effects of cognitive impairment on medication, fluid, and dietary compliance, and ability to make advance directive decisions among dialysis patients. While much remains to be learned regarding the pathophysiology of cognitive impairment in kidney disease, the public health implications of this substantial burden are immediate.

show abstract

Section: Prevalence Of Cognitive Impairment In Hemodialysis Patientssupporting

confidence: 83%

Section: Cognitive Impairment In Chronic Kidney Disease Patientsmentioning

confidence: 94%

Section: Prevalence Of Cognitive Impairment In Hemodialysis Patientsmentioning

confidence: 99%

Section: Cognitive Impairment In Chronic Kidney Disease Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

344

241

View full text Add to dashboard Cite

show abstract

“…Vascular dementia may worsen if the patient is treated with dialysis, which may explain why the majority postpone the start of dialysis therapy. [22][23][24] However, respondents stressed that the severity rather than the presence of vascular dementia has a role in their decision making.…”

Section: Most Frequently Mentioned Reasons As Basis For Opinion (% Ofmentioning

confidence: 99%

Factors Influencing the Decision to Start Renal Replacement Therapy: Results of a Survey Among European Nephrologists

Luijtgaarden

Noordzij

Tomson

et al. 2012

American Journal of Kidney Diseases

View full text Add to dashboard Cite

Background:Little is known about the criteria nephrologists use in the decision of when to start renal replacement therapy (RRT) in early referred adult patients. We evaluated opinions of European nephrologists on the decision for when to start RRT.Study Design: European web-based survey. Predictors: Patient presentations described as uncomplicated patients, patients with unfavorable clinical and unfavorable social conditions, or patients with specific clinical, social, and logistical factors.Setting & Participants: Nephrologists from 11 European countries. Outcomes & Measurements:We studied opinions of European nephrologists about the influence of clinical, social, and logistical factors on decision making regarding when to start RRT, reflecting practices in place in 2009. Questions included target levels of kidney function at the start of RRT and factors accelerating or postponing RRT initiation. Using linear regression, we studied determinants of target estimated glomerular filtration rate (eGFR) at the start of RRT.Results: We received 433 completed surveys. The median target eGFR selected to start RRT in uncomplicated patients was 10.0 (25th-75th percentile, 8.0-10.0) mL/min/1.73 m 2 . Level of excretory kidney function was considered the most important factor in decision making regarding uncomplicated patients (selected by 54% of respondents); in patients with unfavorable clinical versus social conditions, this factor was selected by 24% versus 32%, respectively. Acute clinical factors such as life-threatening hyperkalemia refractory to medical therapy (100%) and uremic pericarditis (98%) elicited a preference for an immediate start, whereas patient preference (69%) and vascular dementia (66%) postponed the start. Higher target eGFRs were reported by respondents from highversus low-RRT-incidence countries (10.4 [95% CI, 9.9-10.9] vs 9.1 mL/min/1.73 m 2 ) and from for-profit versus not-for-profit centers (10.1 [95% CI, 9.5-10.7] vs 9.5 mL/min/1.73 m 2 ).Limitations: We were unable to calculate the exact response rate and examined opinions rather than practice for 433 nephrologists.Conclusions: Only for uncomplicated patients did half the nephrologists consider excretory kidney function as the most important factor. Future studies should assess the weight of each factor affecting decision making. Am J Kidney Dis. 60 (6) P atients with end-stage renal disease (ESRD) receive renal replacement therapy (RRT) to improve their survival and quality of life. The decision of when to start RRT is likely to be guided by the level and rate of decrease in residual kidney function and the clinical condition of the patient. Whereas RRT might be life-saving in certain conditions, dialysis also is unphysiologic and may have life-threatening complications. It carries a significant burden for patients and consumes substantial health care resources. 1 Many studies evaluating associations between the timing of the start of RRT and survival were limited in that they considered only serum creatinine level, which is decreased in pa...

show abstract

Cystatin C as a marker of cognitive function in elders: Findings from the health ABC study

Yaffe

Lindquist

Shlipak

et al. 2008

Annals of Neurology

Self Cite

109

111

View full text Add to dashboard Cite

We determined whether serum cystatin C, a novel measure of kidney function that colocalizes with brain beta-amyloid, is associated with cognition among 3,030 elders. Those with high cystatin C (n = 445; 15%) had worse baseline scores on Modified Mini-Mental State Examination or Digit Symbol Substitution Test (p or=1.0 standard deviation) was greatest among those with high cystatin C (Modified Mini-Mental State Examination: 38 vs 25%; adjusted odds ratio, 1.92; 95% confidence interval, 1.37-2.69; Digit Symbol Substitution: 38 vs 26%; odds ratio, 1.54; 95% confidence interval, 1.10-2.15).

show abstract

Cognitive Impairment in Chronic Kidney Disease

Abstract: Cognitive impairment is associated with the severity of kidney disease. Further studies are needed to determine the reasons for cognitive impairment in subjects with CKD and ESRD.

Cited by 396 publications

References 31 publications

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Factors Influencing the Decision to Start Renal Replacement Therapy: Results of a Survey Among European Nephrologists

Cystatin C as a marker of cognitive function in elders: Findings from the health ABC study

Contact Info

Product

Resources

About