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

Abstract

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.

Cognitive Impairment Related to Chronic Kidney Disease Is Associated with a Decreased Abundance of Membrane-Bound Klotho in the Cerebral Cortex

“…In this regard, several lines of evidence point out that Klotho may be relevant for normal cognition. In the absence of CKD, the serum levels of Klotho have shown significant associations with the scores in tests intended to evaluate different cognition domains, such as the Mini-Mental State Examination, the Clinical Dementia Rating, or the Digit Symbol Substitution test [23,24], while low concentrations of Klotho have been related to worse cognition [10]. In line with these observations, Klotho overexpression has been evidenced to improve cognitive function in nonhuman primates [25].…”

“…Thus, it is not surprising that at least part of the relevance of CKD-associated cognitive dysfunction relies on lower treatment compliance [43] along with the worse quality of life experienced by these patients. In this sense, very recent studies have reported apathy symptoms in patients with CKD and lower scores in terms of physical function, social and emotional function, and mental health, among other parameters [24,44].…”