Risk and incidence of cognitive impairment in patients with chronic kidney disease and diabetes: the results from a longitudinal study in a community cohort of patients and an age and gender-matched control cohort in North Wales, UK

Hobson, Peter; Kumwenda, Mick; Shrikanth, Siva; Nair, Hari; Wong, Stephen Phooi Yew

doi:10.1136/bmjopen-2021-053008

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…A chronically maintained state of impaired KF may develop into chronic kidney disease (CKD; i.e., eGFR < 60 mL/min/1.73 m 2 for ≥3 months) 6 . Previous studies have related CKD to cognitive decline 14 and a high risk of dementia 15,16 . However, previous studies exploring the association between impaired KF and dementia showed inconsistent results 17–25 .…”

Section: Introductionmentioning

confidence: 99%

Association of impaired kidney function with dementia and brain pathologies: A community‐based cohort study

Wang

Dove

et al. 2022

Alzheimer's & Dementia

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Introduction The relationship between impaired kidney function (KF), dementia, and brain pathologies remains unclear. Methods A total of 1354 dementia‐ and kidney disease‐free participants including 895 with normal and 459 with impaired KF were followed from 2002 until 2020 (median [interquartile range]: 5 [2–9]) to detect incident dementia. KF was assessed at baseline and categorized as normal or impaired. Over the follow‐up, 453 participants died and underwent autopsies for neuropathological assessment. Results Compared to those with normal KF, the hazard ratios (95% confidence intervals [CIs]) of those with impaired KF was 1.48 (1.15, 1.90)/1.44 (1.10, 1.88) for dementia/Alzheimer's dementia. Furthermore, impaired KF was related to a significantly higher burden of cerebral amyloid angiopathy (CAA; odds ratio = 1.96, 95% CI: 1.17, 3.30), but not to other brain pathologies. Discussion Impaired KF is associated with an increased risk of dementia and Alzheimer's dementia. CAA may underlie, in part, this association. Highlights Impaired kidney function (KF) was associated with higher dementia and Alzheimer's dementia risk. Impaired KF anticipated dementia and Alzheimer's dementia onset by more than 1.5 years. Impaired KF was significantly related to a higher burden of cerebral amyloid angiopathy (CAA) but not to other brain pathologies.

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Section: Introductionmentioning

confidence: 99%

Association of impaired kidney function with dementia and brain pathologies: A community‐based cohort study

Wang

Dove

et al. 2022

Alzheimer's & Dementia

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“…Though a tailored self-management approach is supported by meta-analyses, such responses result in lower CSPAM scores [ 54 , 55 ]. It may be particularly challenging for kidney clinicians to support patients on HD to ‘work out new solutions’ or ‘manage the problem on their own,’ because patients on HD are high-risk and dialysis treatment is very complex, with patients being older, frail, multi-morbid and experiencing cognitive impairment and dementia [ 42 , 56 ]. HD patients may prefer to see their specialist team for advice, as general practitioners may not be confident in managing kidney impairment [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Supporting patient self-management: A cross-sectional and prospective cohort study investigating Patient Activation Measure (PAM) and Clinician Support for PAM scores as part of a multi-centre haemodialysis breakthrough series collaborative

Keriakos,

Lee,

Stannard

et al. 2024

PLoS ONE

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Background Patient self-management, measured by the Patient Activation Measure (PAM), is associated with reduced healthcare utilisation and better health-related quality of life. Self-management in haemodialysis (HD) is challenging and may require support from clinicians with positive attitudes towards self-management, measured by the Clinician Support for PAM (CSPAM). Objectives To assess whether kidney staff CSPAM scores are: 1) associated with their centre’s patient PAM scores and 2) modifiable through staff coaching. Methods Baseline PAM and CSPAM and six-month CSPAM were collected from HD patients and kidney staff respectively in seven UK kidney centres as part of a six-month breakthrough series collaborative (BTSC), which trained kidney staff in supporting patient independence with HD tasks. Firstly, multivariable linear regression analyses adjusted for patient characteristics were used to test the baseline association between centre-level staff CSPAM scores and patient PAM scores. Secondly, paired univariate and unpaired multivariable linear regression analyses were conducted to compare staff CSPAM scores at baseline and six months. Results 236 PAM questionnaires (mean score = 55.5) and 89 CSPAM questionnaires (median score = 72.6) were analysed at baseline. There was no significant association between centre-level mean CSPAM scores and PAM scores in univariate analyses (P = 0.321). After adjusting for patient-level characteristics, increasing centre-level mean CSPAM score by 1 point resulted in a non-significant 0.3-point increase in PAM score (0.328 (95% CI: -0.157 to 0.812; P = 0.184). Paired (n = 37) and unpaired (n = 174) staff analyses showed a non-significant change in CSPAM scores following the BTSC intervention (mean change in CSPAM score in unpaired analysis = 1.339 (95% CI: -1.945 to 4.623; P = 0.422). Conclusions Lack of a significant: 1) association between CSPAM and PAM scores and 2) change in CSPAM scores suggest that modifying staff beliefs alone is less likely to influence patient self-management, requiring co-production between patients and staff.

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“…The relationship between renal dysfunction and CI has been repeatedly reported. Clinical studies have suggested that patients with CKD have a higher risk of developing CI in comparison with the normal population [15]. In a longitudinal study, Murray et al found an association between mild albuminuria and worse cognitive function and cognitive decline [16].…”

Section: Discussionmentioning

confidence: 99%

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

Rodríguez-Ortiz,

Jurado-Montoya,

Valdés-Díaz

et al. 2024

IJMS

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Cognitive impairment (CI) is a complication of chronic kidney disease (CKD) that is frequently observed among patients. The aim of this study was to evaluate the potential crosstalk between changes in cognitive function and the levels of Klotho in the brain cortex in an experimental model of CKD. To induce renal damage, Wistar rats received a diet containing 0.25% adenine for six weeks, while the control group was fed a standard diet. The animals underwent different tests for the assessment of cognitive function. At sacrifice, changes in the parameters of mineral metabolism and the expression of Klotho in the kidney and frontal cortex were evaluated. The animals with CKD exhibited impaired behavior in the cognitive tests in comparison with the rats with normal renal function. At sacrifice, CKD-associated mineral disorder was confirmed by the presence of the expected disturbances in the plasma phosphorus, PTH, and both intact and c-terminal FGF23, along with a reduced abundance of renal Klotho. Interestingly, a marked and significant decrease in Klotho was observed in the cerebral cortex of the animals with renal dysfunction. In sum, the loss in cerebral Klotho observed in experimental CKD may contribute to the cognitive dysfunction frequently observed among patients. Although further studies are required, Klotho might have a relevant role in the development of CKD-associated CI and represent a potential target in the management of this complication.

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Risk and incidence of cognitive impairment in patients with chronic kidney disease and diabetes: the results from a longitudinal study in a community cohort of patients and an age and gender-matched control cohort in North Wales, UK

Cited by 6 publications

References 35 publications

Association of impaired kidney function with dementia and brain pathologies: A community‐based cohort study

Association of impaired kidney function with dementia and brain pathologies: A community‐based cohort study

Supporting patient self-management: A cross-sectional and prospective cohort study investigating Patient Activation Measure (PAM) and Clinician Support for PAM scores as part of a multi-centre haemodialysis breakthrough series collaborative

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

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