Cognitive Impairment in Peritoneal Dialysis Patients

Abstract

Background Prevalence of moderate to severe cognitive impairment among hemodialysis patients is more than double the prevalence in the general population. This study describes cognitive impairment occurrence in a peritoneal dialysis cohort compared with a cohort without chronic kidney disease (CKD). Study Design Cross-sectional study. Setting and Participants 51 English-speaking peritoneal dialysis patients from two urban dialysis units, compared with 338 hemodialysis patients from 16 urban dialysis units and 101voluntary controls without CKD from urban general medicine clinics. Predictor A 45-minute battery of nine validated neuropsychological tests (cognitive domains memory, executive function, language). Outcomes Mild, moderate, or severe cognitive impairment, classified according to a previously designed algorithm. Results Of the peritoneal dialysis cohort, 33.3% had no or mild, 35.3% moderate, and 31.4% severe cognitive impairment; corresponding values were 60.4%, 26.7%, and 12.9% of the non-CKD cohort, and 26.6%, 36.4%, and 37.0% of the hemodialysis cohort. A logistic regression model including age, sex, race, education, hemoglobin, diabetes, and stroke showed that only non-white race (P = 0.002) and education (P = 0.002) were associated with moderate to severe cognitive impairment in the peritoneal dialysis cohort. Compared with hemodialysis patients, more peritoneal dialysis patients had moderate to severe memory impairment (60% vs. 52%), but fewer had impaired executive function (one-third vs. one-half). Peritoneal dialysis was associated with a more than 2.5-fold increased risk of moderate to severe cognitive impairment compared with no CKD (OR, 2.58; 95% confidence interval 1.02-6.53), as was hemodialysis (OR, 3.16; 95% CI, 1.91-5.24), in an adjusted logistic regression model. Limitations Small sample size, participation rate somewhat low. Conclusions Similar to hemodialysis patients, two-thirds of peritoneal dialysis patients had moderate to severe cognitive impairment, enough to interfere with safely self-administering dialysis and adhering to complex medication regimens. These patients could benefit from cognitive assessment before and periodically after dialysis initiation.

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

“…Both impaired cognitive function (33)(34)(35) and reduced physical performance measures (2,20,36) have been previously reported in patients established on PD. However, previous studies have not included data regarding functional independence.…”

“…These include a potential for survival bias that may have resulted in an underestimation of the burden of disability, inability to generalize across all populations, and a lack of longitudinal outcome data. Several studies have noted that patients on dialysis (both HD and PD) have a high burden of cognitive impairment (34,37,38). Through our choice chair without the use of their arms or an aid, while 51% were unable to perform the TUG mobility test within the normal range of 0-10 s.…”

The Needs of Older Patients for Peritoneal Dialysis: Training and Support at Home

“…Probably the most significant assessment at this stage is cognition as this will have considerable influence on their skills to perform or remember tasks (21). Often, formal or informal assessments of cognitive ability are not undertaken and can be one of the reasons patients are seen to fail in training (15). A simple recommended tool is the Montreal Cognitive Assessment (MOCA) tool (15) which can be performed in 10 minutes.…”

“…Many older patients have multiple morbidities, all of which can impact on their physical and mental health, affecting disability and ability in performing activities of daily life (15). Educational interventions can play a crucial role in the success of individuals in managing their own treatments.…”

Geriatric Assessment, Falls and Rehabilitation in Patients Starting or Established on Peritoneal Dialysis

“…Cognitive dysfunction appears equally common and severe as in the HD population, as does functional decline (8,9). Functional decline may manifest in multiple ways.…”