Journal article
Cognitive Impairment in Non-Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
American journal of kidney diseases, v 72(4), pp 499-508
Oct 2018
PMID: 29728316
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Advanced chronic kidney disease is associated with elevated risk for cognitive impairment. However, it is not known whether and how cognitive impairment is associated with planning and preparation for end-stage renal disease.
Retrospective observational study.
630 adults participating in the CRIC (Chronic Renal Insufficiency Cohort) Study who had cognitive assessments in late-stage CKD, defined as estimated glome-rular filtration rate ≤ 20mL/min/1.73m
, and subsequently initiated maintenance dialysis therapy.
Predialysis cognitive impairment, defined as a score on the Modified Mini-Mental State Examination lower than previously derived age-based threshold scores. Covariates included age, race/ethnicity, educational attainment, comorbid conditions, and health literacy.
Peritoneal dialysis (PD) as first dialysis modality, preemptive permanent access placement, venous catheter avoidance at dialysis therapy initiation, and preemptive wait-listing for a kidney transplant.
Multivariable-adjusted logistic regression.
Predialysis cognitive impairment was present in 117 (19%) participants. PD was the first dialysis modality among 16% of participants (n=100), 75% had preemptive access placed (n=473), 45% avoided using a venous catheter at dialysis therapy initiation (n=279), and 20% were preemptively wait-listed (n=126). Predialysis cognitive impairment was independently associated with 78% lower odds of PD as the first dialysis modality (adjusted OR [aOR], 0.22; 95% CI, 0.06-0.74; P=0.02) and 42% lower odds of venous catheter avoidance at dialysis therapy initiation (aOR, 0.58; 95% CI, 0.34-0.98; P=0.04). Predialysis cognitive impairment was not independently associated with preemptive permanent access placement or wait-listing.
Potential unmeasured confounders; single measure of cognitive function.
Predialysis cognitive impairment is associated with a lower likelihood of PD as a first dialysis modality and of venous catheter avoidance at dialysis therapy initiation. Future studies may consider addressing cognitive function when testing strategies to improve patient transitions to dialysis therapy.
Metrics
Details
- Title
- Cognitive Impairment in Non-Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
- Creators
- Meera N Harhay - Drexel UniversityDawei Xie - University of PennsylvaniaXiaoming Zhang - University of PennsylvaniaChi-Yuan Hsu - University of California, San FranciscoEric Vittinghoff - University of California, San FranciscoAlan S Go - University of California, San FranciscoStephen M Sozio - Johns Hopkins MedicineJacob Blumenthal - University of Maryland, BaltimoreStephen Seliger - University of Maryland, BaltimoreJing Chen - Tulane UniversityRajat Deo - University of PennsylvaniaMirela Dobre - University Hospitals of ClevelandSanjeev Akkina - Loyola University Medical CenterPeter P Reese - University of PennsylvaniaJames P Lash - University of Illinois ChicagoKristine Yaffe - University of California, San FranciscoManjula Kurella TamuraCRIC Study Investigators
- Publication Details
- American journal of kidney diseases, v 72(4), pp 499-508
- Grant note
- U01 DK060963 / NIDDK NIH HHS U01 DK060990 / NIDDK NIH HHS P20 GM109036 / NIGMS NIH HHS U01 DK061028 / NIDDK NIH HHS U01 DK061022 / NIDDK NIH HHS UL1 TR002240 / NCATS NIH HHS U01 DK060902 / NIDDK NIH HHS M01 RR016500 / NCRR NIH HHS UL1 RR029879 / NCRR NIH HHS UL1 TR000424 / NCATS NIH HHS R01 DK069406 / NIDDK NIH HHS U01 DK060984 / NIDDK NIH HHS P30 AG028747 / NIA NIH HHS UL1 RR024131 / NCRR NIH HHS U01 DK061021 / NIDDK NIH HHS UL1 TR000433 / NCATS NIH HHS K24 DK092290 / NIDDK NIH HHS R01 DK072231 / NIDDK NIH HHS K23 DK105207 / NIDDK NIH HHS UL1 TR002003 / NCATS NIH HHS U01 DK060980 / NIDDK NIH HHS UL1 TR000439 / NCATS NIH HHS U24 DK060990 / NIDDK NIH HHS UL1 TR002548 / NCATS NIH HHS UL1 TR000003 / NCATS NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000445122300007
- Scopus ID
- 2-s2.0-85046793888
- Other Identifier
- 991019335327404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Urology & Nephrology