The comparison of cognitive function and risk of dementia in CKD patients under peritoneal dialysis and hemodialysis

Tian, Xiaolin; Guo, Xingming; Xia, Xiaoshuang; Yu, Haibo; Li, Xin; Jiang, Aili

doi:10.1097/md.0000000000014390

Cited by 43 publications

(32 citation statements)

References 42 publications

(69 reference statements)

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“…In addition, peritoneal dialysis has been reported to be more effective than hemodialysis in reversing uremic encephalopathy (Wolcott et al, 1988), and the risk of dementia for patients who started on peritoneal dialysis is lower compared with those who started on hemodialysis (Wolfgram et al, 2015). These results were confirmed by a recent systematic review and meta-analysis, which concluded that peritoneal dialysis is better in preserving the cognitive functions and is associated with a lower risk of dementia in comparison with hemodialysis (Tian et al, 2019).…”

Section: Cognitive Impairment In Ckdmentioning

confidence: 57%

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Neuropsychiatric Disorders in Chronic Kidney Disease

Silva

Miranda²,

Rocha

et al. 2019

Front. Pharmacol.

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Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with chronic kidney disease (CKD). These conditions often make worse the quality of life and also lead to longer hospitalizations and higher mortality. Over the past decades, some hypotheses have tried to explain the connection between CKD and neuropsychiatric disorders. The most common hypothesis is based on the occurrence of cerebrovascular disease and accumulated uremic toxins in adult patients with CKD. However, the lack of a direct association between known vascular risk factors (e.g., diabetes and hypertension) with CKD-related cognitive deficits suggests that other mechanisms may also play a role in the pathophysiology shared by renal and neuropsychiatric diseases. This hypothesis is corroborated by the occurrence of neuropsychiatric comorbidities in pediatric patients with CKD preceding vascular damage, and the inconsistent findings on neuroprotective effects of antihypertensives. The aim of this narrative review was to summarize clinical evidence and potential mechanisms that links CKD and brain disorders, specifically in regard to cognitive impairment, anxiety, and depression.

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Section: Cognitive Impairment In Ckdmentioning

confidence: 57%

“…A recent study indicated that for every 10 ml decrease in the estimated GFR below 60 ml/min/1.73 m 2 , there is an 11% increase in the risk of cognitive impairment (Tian et al, 2019). A meta-analysis of cross-sectional and longitudinal studies comprising 54,779 participants corroborated these findings.…”

Section: Cognitive Impairment In Ckdmentioning

confidence: 99%

Neuropsychiatric Disorders in Chronic Kidney Disease

Silva

Miranda²,

Rocha

et al. 2019

Front. Pharmacol.

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“…Kidney function and the type of associated replacement therapy are associated with cognitive impairment [34][35][36][37]. Previous studies have found that cognitive impairment can decline when patients start hemodialysis [38][39][40], and in our study, 61% of the patients were on hemodialysis. Of our seven patients with cognitive impairment, five were on hemodialysis and two on peritoneal dialysis, although these differences were not statistically significant.…”

Section: Discussionmentioning

confidence: 46%

Evaluation of cerebral dysfunction in patients with chronic kidney disease using neuropsychometric and neurophysiological tests

et al. 2021

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Background: Uremic encephalopathy is defined as cerebral dysfunction due to toxin accumulation in patients with chronic kidney disease (CKD). This condition is characterized by subtle to florid symptoms, and its clinical course is always progressive when untreated but partially reversible with renal replacement therapy. While no test exists to measure subclinical uremic encephalopathy, two tests have been validated to measure minimal hepatic encephalopathy: the critical flicker frequency (CFF) test and the psychometric hepatic encephalopathy score (PHES). Objective: To use CFF and PHES to measure the prevalence of cerebral dysfunction in individuals with CKD. Methods: This cross-sectional study included a total of 69 patients with stage-5 CKD. Cutoff points for minimal encephalopathy were established using existing clinical guidelines: 39 Hz for CFF and < À4 for PHES. All participants were also screened for cognitive function and depression. Results: Eighteen cases (26.1%) of cerebral dysfunction linked to uremic encephalopathy were detected with CFF, while twelve (17.4%) were detected by PHES; only six cases (8.7%) were diagnosed by both methods. Half of the cases (50%) had diabetes, and 61% were on hemodialysis. Cognitive function scores did not differ significantly between those receiving dialysis, hemodialysis, or no renal replacement therapy. Conclusions: It is essential to identify cerebral dysfunction when uremic encephalopathy is in early subclinical stages to reduce preventable events as traffic and work accidents.

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“…Serum albumin level was an independently favorable factor to maintain the cognitive function as shown in our multicenter prospective cohort study [47]. A recent meta-analysis study indicated that PD might be superior in preserving the cognitive functions and decreasing the risk of dementia compared with hemodialysis from totally 15 cohort or cross-sectional studies [48]. The authors explained that the continuity and stability of PD therapy is beneficial for restoring the cognitive function.…”

Section: Discussionmentioning

confidence: 60%

Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis

Li¹,

Yang³

et al. 2019

J Nephrol

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Background Uremic toxins have been suspected as potential contributors for cognitive impairment in peritoneal dialysis (PD) patients. However, associations between the clearance of serum small and middle molecules and the change of cognitive function were not fully explored and then we explored this issue in the present study. Method A total of clinically-stable 222 patients on PD were enrolled and then followed up for 2 years in this single-center prospective cohort study. Small and middle molecules clearances were examined by urea clearance (Kt/V), creatinine clearance (Ccr) and beta-2 microglobulin (B2M) clearance via dialysate and urine at baseline and after 2 years. Global and specific cognitive impairment were measured at baseline and after 2 years. Modified Mini-Mental State Examination (3MS) was assessed for global cognitive function, trail-making tests A and B for executive function and subtests of the battery for the assessment of neuropsychological status for immediate and delayed memory, visuospatial skills and language ability. Results The median of total Kt/V, Ccr and B2M clearance were 1.89, 53.2 l/w/1.73 m 2 and 17.5 l/w/1.73 m 2 , respectively at baseline. The prevalence of global cognitive impairment was 12.3% for 222 patients and 15.4% for the remained 130 patients after 2 years. At baseline, total Kt/V was independently positively associated with delayed memory function. Total and dialysate beta-2 microglobulin clearance was positively associated with 3MS scores and negatively with completion time on trail A after multivariate adjustment. At 2 years, we observed a significant difference in the changing trend of 3MS scores between groups divided by total B2M clearance (P = 0.033), which still maintained to be meaningful after multivariate adjustment (P = 0.024). Patients with total B2M clearance > 19.0 l/w/1.73 m 2 got significant improvement on their 3MS scores (P = 0.005). Patients divided by total Kt/V or Ccr were not significantly different in the trends of general and any specific cognitive function during the follow up. Conclusion The higher middle molecules clearance independently correlated to better performance on general cognitive and executive function in PD patients, which also predict an improvement in general cognitive function during the follow up.

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The comparison of cognitive function and risk of dementia in CKD patients under peritoneal dialysis and hemodialysis

Cited by 43 publications

References 42 publications

Neuropsychiatric Disorders in Chronic Kidney Disease

Neuropsychiatric Disorders in Chronic Kidney Disease

Evaluation of cerebral dysfunction in patients with chronic kidney disease using neuropsychometric and neurophysiological tests

Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis

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