The Association of Cognitive Impairment with Peritoneal Dialysis-Related Peritonitis

Abstract

Background Research on the association between cognitive impairment (CI) and peritoneal dialysis (PD)-related peritonitis is limited. Therefore, we investigated whether CI contributed to the risk of PD-related peritonitis. Methods This prospective cohort study enrolled 458 patients from 5 PD centers between 1 March 2013, and 30 November 2013, and continued until 31 May 2016. We used the Modified Mini- Mental State Examination (3MS) to assess general cognition, the Trail-Making Test to assess executive function, and subtests of the Battery for the Assessment of Neuropsychological Status to assess immediate and delayed memory, visuospatial skills, and language ability. Patients were assigned to CI and non-CI groups based on their 3MS scores. The first episode of peritonitis was the primary endpoint event. Treatment failure of peritonitis was defined as peritonitis-associated death or transfer to hemodialysis. We used competing risk models to analyze the association between CI and the risk of peritonitis. The association of CI with treatment failure after peritonitis was analyzed using logistic regression models. Results Ninety-four first episodes of peritonitis were recorded during a median follow-up of 31.4 months, 18.1% of which led to treatment failure. No significant group differences were observed for the occurrence, distribution of pathogenic bacteria, or outcomes of first-episode peritonitis. Immediate memory dysfunction was independently associated with a higher risk of PD-related peritonitis (hazard ratio [HR] 1.736, 95% confidence interval [CI] 1.064 – 2.834, p < 0.05), adjusting for confounders. Conclusions Immediate memory dysfunction was a significant, independent predictor of PD-related peritonitis. Neither general nor specific domains of CI predicted treatment failure of peritonitis.

Self-care or assisted PD: development of a new approach to evaluate manual peritoneal dialysis practice ability

“…Functional and cognitive impairments are highly prevalent in patients with kidney failure and are independent predictors for adverse health outcomes [ 10 ]. In addition, in PD patients, physical barriers and cognitive dysfunction are shown to be associated with increased risk of PD-related peritonitis after adjusting for confounders [ 11 , 12 ]. Thus, routine screening for physical and cognitive impairments is recommended to be included as part of assessment for maintenance PD [ 13 ].…”

Impact of assistance on peritonitis due to breach in aseptic procedure in diabetic patients: A cohort study with the RDPLF data

“…In a recent study reporting that empowerment in PD is strengthened by supportive relationships, 36 patients were able to gain reassurance with practical assistance. Moreover, the family member/helper may also have better cognitive function 37 and manual dexterity. However, in our study, the protective effect of family assistance was lower than that of nurse assistance (sd-RH of 0.52, 95% CI 0.40-0.67, for nurse assistance and 0.70, 95% CI 0.51-0.95, for family assistance).…”

Evaluation of modifiable risk factors for peritoneal dialysis-related peritonitis: a single-center retrospective cohort study

“…Depression has been reported to be the leading psychiatric disorder associated with peritonitis, but cognitive dysfunction affected the majority of patients in this study. Immediate memory dysfunction, rather than general cognitive impairment, can predict a higher risk of PD-related peritonitis [24]. Therefore, we must keep in mind that regular assessments of a patient's cognitive function may help prevent peritonitis.…”