Predictors of Cognitive Dysfunction among Patients with Moderate to Severe Chronic Kidney Disease

Abstract

Cognitive dysfunction including dementia is a common complication of chronic kidney disease (CKD) that has just been recently appreciated. It has negative outcomes in the management of patients with CKD. This study explored the possible biochemical and clinical features of patients with CKD that can predict the occurrence of cognitive impairment in patients with moderate to severe CKD. We evaluate patients with stages 3-5 CKD for the occurrence and predictors of cognitive impairment. Multiple areas of cognitive function were tested in this single-center study using Community Screening Interview for Dementia (CSID) and Trial-Making Test A (TMTA)/Trial-Making Test B (TMTB). Cognitive impairment was correlated with patients' routine biochemical, hematological, and selected clinical parameters. We observed a negative correlation between cognitive impairment and patient's serum calcium (r 5 0.240; p 5 0.033) and estimated Glomerular filtration rate (eGFR) (r 5 0.379; p 5 0.0006). Therefore, eGFR is an accurate predictor of cognitive dysfunction in patients with moderate to severe CKD. Early evaluation of cognitive function in CKD is indeed advised for optimal outcome in the management of patients with CKD.

Cognitive Impairment in Patient With Chronic Kidney Disease

“…Tingginya insiden iskemia serebral dalam etiopatogenesis gangguan kognitif pada CKD diperkirakan terjadi karena faktor risiko mikrovaskular bersama antara CKD dan iskemia otak. 11 ISSN 2301-5977, e-ISSN 2527-7154 jku.unram.ac.id Secara garis besar gangguan fungsi kognitif tersebut disebabkan oleh 4 faktor. Faktor tersebut meliputi 1) sindrom azotemia, 2) Hemodialisis, 3) faktor risiko vaskular 4) komorbid Gagal Ginjal Kronis.…”

“…4 Diagnosis dini dan pengobatan segera untuk memperlambat kemajuan penurunan fungsi kognitif pada pasien dengan CKD sangat penting, karena fungsi kognitif yang buruk telah dikaitkan dengan risiko kematian yang lebih besar pada pasien dialisis, kepatuhan yang buruk terhadap pengobatan dan peningkatan kejadian penyakit serebrovaskular serta rawat inap yang lebih lama. 11 Selain menjadi kontributor yang signifikan terhadap kematian, fungsi kognitif adalah penentu utama kualitas hidup karena pengambilan keputusan dan kepatuhan pasien terhadap prinsipprinsip manajemen farmakologis dan nonfarmakologis bergantung pada keadaan kognitifnya. 11…”