Abstract

Observational Study

Cognitive Impairment in Renal Replacement Therapy: Comparison between Methods

Paribello Giuseppe*, Papa Fortuna, Ganzerli Maria Chiara, Del Prete Chiara, Lanzuise Caterina, Capuano Ivana, Pacella Daniela, Sannino Giuseppina, Rompianesi Gianluca, Pisani Antonio and Riccio Eleonora

Published: 29 January, 2024 | Volume 8 - Issue 1 | Pages: 001-007

Cognitive impairment (CI) can be defined as a clinical syndrome characterized by a decline in at least two of several domains of cognitive function. Chronic kidney disease (CKD) is an independent risk factor for cognitive decline, and the prevalence in patients with end-stage renal disease is estimated at 50% - 80%. However, it appears that CI in patients on renal replacement therapy (RRT) may be underdiagnosed. In this cross-sectional study, 33 patients on Peritoneal Dialysis from the AOU Federico II were recruited, and matched by sex, age, and dialysis age to 33 patients on Hemodialysis and 33 controls belonging to healthy volunteers. The total 66 patients and their 33 controls were assessed for cognitive function using the Cognitive Reserve Index Questionnaire (CRIq) test. Between PD and HD patients, a statistically significant difference emerged in all subscores and in the total CRI. Between PD patients and controls, a statistically significant difference emerged in education, CRI- CRI-leisure time, and the total CRI. Therefore, CI may occur in patients undergoing PD earlier and with a greater frequency than in the general population, but with a lower incidence than in patients on HD. These considerations should be communicated to patients when they are educated about different replacement methods.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001119 Cite this Article Read Full Article PDF

Keywords:

Peritoneal dialysis; Cognitive impairment; Cognitive reserve index questionnaire; Chronic kidney disease

References

  1. Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement. 2015 Jun;11(6):718-26. doi: 10.1016/j.jalz.2015.05.016. Epub 2015 Jun 1. PMID: 26045020.
  2. Kalirao P, Pederson S, Foley RN, Kolste A, Tupper D, Zaun D, Buot V, Murray AM. Cognitive impairment in peritoneal dialysis patients. Am J Kidney Dis. 2011 Apr;57(4):612-20. doi: 10.1053/j.ajkd.2010.11.026. Epub 2011 Feb 4. Erratum in: Am J Kidney Dis. 2011 Jun;57(6):966. PMID: 21295896; PMCID: PMC3121243.
  3. Collins AJ, Li S, Ma JZ, Herzog C. Cardiovascular disease in end-stage renal disease patients. Am J Kidney Dis. 2001 Oct;38(4 Suppl 1):S26-9. doi: 10.1053/ajkd.2001.27392. PMID: 11576917.
  4. Levin A. Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial. 2003 Mar-Apr;16(2):101-5. doi: 10.1046/j.1525-139x.2003.16025.x. PMID: 12641872.
  5. Olczyk P, Kusztal M, Gołębiowski T, Letachowicz K, Krajewska M. Cognitive Impairment in End Stage Renal Disease Patients Undergoing Hemodialysis: Markers and Risk Factors. Int J Environ Res Public Health. 2022 Feb 18;19(4):2389. doi: 10.3390/ijerph19042389. PMID: 35206577; PMCID: PMC8877881.
  6. Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Renal Data System. Bethesda MD. 2005.
  7. Kim CD, Lee HJ, Kim DJ, Kim BS, Shin SK, Do JY, Jang MH, Park SH, Kim YS, Kim YL. High prevalence of leukoaraiosis in cerebral magnetic resonance images of patients on peritoneal dialysis. Am J Kidney Dis. 2007 Jul;50(1):98-107. doi: 10.1053/j.ajkd.2007.03.019. PMID: 17591529.
  8. Fernando MS, Simpson JE, Matthews F, Brayne C, Lewis CE, Barber R, Kalaria RN, Forster G, Esteves F, Wharton SB, Shaw PJ, O'Brien JT, Ince PG; MRC Cognitive Function and Ageing Neuropathology Study Group. White matter lesions in an unselected cohort of the elderly: molecular pathology suggests origin from chronic hypoperfusion injury. Stroke. 2006 Jun;37(6):1391-8. doi: 10.1161/01.STR.0000221308.94473.14. Epub 2006 Apr 20. PMID: 16627790.
  9. Schmidt R, Petrovic K, Ropele S, Enzinger C, Fazekas F. Progression of leukoaraiosis and cognition. Stroke. 2007 Sep;38(9):2619-25. doi: 10.1161/STROKEAHA.107.489112. Epub 2007 Aug 2. PMID: 17673724.
  10. Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L; LADIS Study Group. Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ. 2009 Jul 6;339:b2477. doi: 10.1136/bmj.b2477. PMID: 19581317; PMCID: PMC2714680.
  11. Khawar O, Kalantar-Zadeh K, Lo WK, Johnson D, Mehrotra R. Is the declining use of long-term peritoneal dialysis justified by outcome data? Clin J Am Soc Nephrol. 2007 Nov;2(6):1317-28. doi: 10.2215/CJN.02550607. Epub 2007 Oct 17. PMID: 17942769.
  12. Cereda E, Sacchi MC, Malavazos AE. Central obesity and increased risk of dementia more than three decades later. Neurology. 2009 Mar 17;72(11):1030-1; author reply 1031. doi: 10.1212/01.wnl.0000343499.72241.ea. PMID: 19289749.
  13. Yaffe K, Weston AL, Blackwell T, Krueger KA. The metabolic syndrome and development of cognitive impairment among older women. Arch Neurol. 2009 Mar;66(3):324-8. doi: 10.1001/archneurol.2008.566. PMID: 19273750; PMCID: PMC2685462.
  14. Kanaya AM, Lindquist K, Harris TB, Launer L, Rosano C, Satterfield S, Yaffe K; Health ABC Study. Total and regional adiposity and cognitive change in older adults: The Health, Aging and Body Composition (ABC) study. Arch Neurol. 2009 Mar;66(3):329-35. doi: 10.1001/archneurol.2008.570. PMID: 19273751; PMCID: PMC2739693.
  15. Wu PH, Lin YT, Wu PY, Huang JC, Chen SC, Chang JM, Chen HC. A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis. Dis Markers. 2019 Aug 19;2019:9421352. doi: 10.1155/2019/9421352. PMID: 31531128; PMCID: PMC6721107.
  16. Tasmoc A, Donciu MD, Veisa G, Nistor I, Covic A. Increased arterial stiffness predicts cognitive impairment in hemodialysis patients. Hemodial Int. 2016 Jul;20(3):463-72. doi: 10.1111/hdi.12406. Epub 2016 Feb 9. PMID: 26861856.
  17. Liu W, Wang L, Huang X, Yuan C, Li H, Yang J. Orthostatic blood pressure reduction as a possible explanation for memory deficits in dialysis patients. Hypertens Res. 2019 Jul;42(7):1049-1056. doi: 10.1038/s41440-019-0236-4. Epub 2019 Mar 1. PMID: 30824825.
  18. Bossola M, Tazza L, Vulpio C, Luciani G. Is regression of left ventricular hypertrophy in maintenance hemodialysis patients possible? Semin Dial. 2008 Sep-Oct;21(5):422-30. doi: 10.1111/j.1525-139X.2008.00471.x. Epub 2008 Aug 28. PMID: 18764802.
  19. Middleton RJ, Parfrey PS, Foley RN. Left ventricular hypertrophy in the renal patient. J Am Soc Nephrol. 2001 May;12(5):1079-1084. doi: 10.1681/ASN.V1251079. PMID: 11316868.
  20. Prohovnik I, Post J, Uribarri J, Lee H, Sandu O, Langhoff E. Cerebrovascular effects of hemodialysis in chronic kidney disease. J Cereb Blood Flow Metab. 2007 Nov;27(11):1861-9. doi: 10.1038/sj.jcbfm.9600478. Epub 2007 Apr 4. PMID: 17406658.
  21. Bossola M, Laudisio A, Antocicco M, Tazza L, Colloca G, Tosato M, Zuccalà G. Cognitive performance is associated with left ventricular function in older chronic hemodialysis patients: result of a pilot study. Aging Clin Exp Res. 2014 Aug;26(4):445-51. doi: 10.1007/s40520-013-0191-x. Epub 2013 Dec 19. PMID: 24353108.
  22. MacEwen C, Sutherland S, Daly J, Pugh C, Tarassenko L. Relationship between Hypotension and Cerebral Ischemia during Hemodialysis. J Am Soc Nephrol. 2017 Aug;28(8):2511-2520. doi: 10.1681/ASN.2016060704. Epub 2017 Mar 7. PMID: 28270412; PMCID: PMC5533227.
  23. Polinder-Bos HA, García DV, Kuipers J, Elting JWJ, Aries MJH, Krijnen WP, Groen H, Willemsen ATM, van Laar PJ, Strijkert F, Luurtsema G, Slart RHJA, Westerhuis R, Gansevoort RT, Gaillard CAJM, Franssen CFM. Hemodialysis Induces an Acute Decline in Cerebral Blood Flow in Elderly Patients. J Am Soc Nephrol. 2018 Apr;29(4):1317-1325. doi: 10.1681/ASN.2017101088. Epub 2018 Mar 1. Erratum in: J Am Soc Nephrol. 2018 Aug;29(8):2256. PMID: 29496888; PMCID: PMC5875962.
  24. Viana JL, Kosmadakis GC, Watson EL, Bevington A, Feehally J, Bishop NC, Smith AC. Evidence for anti-inflammatory effects of exercise in CKD. J Am Soc Nephrol. 2014 Sep;25(9):2121-30. doi: 10.1681/ASN.2013070702. Epub 2014 Apr 3. PMID: 24700875; PMCID: PMC4147973.
  25. Carlsson AC, Carrero JJ, Stenvinkel P, Bottai M, Barany P, Larsson A, Ärnlöv J. Endostatin, Cathepsin S, and Cathepsin L, and Their Association with Inflammatory Markers and Mortality in Patients Undergoing Hemodialysis. Blood Purif. 2015;39(4):259-65. doi: 10.1159/000381664. Epub 2015 Apr 29. PMID: 25924922.
  26. Norden DM, Godbout JP. Review: microglia of the aged brain: primed to be activated and resistant to regulation. Neuropathol Appl Neurobiol. 2013 Feb;39(1):19-34. doi: 10.1111/j.1365-2990.2012.01306.x. PMID: 23039106; PMCID: PMC3553257.
  27. Prelevic V, Radunovic D, Antunovic T, Ratkovic M, Gligorovic-Bahranovic N, Gledovic B, Vujosevic S, Nedovic-Vukovic M, Basic-Jukic N. Increased Serum Level of IGF-1 Correlates With Better Cognitive Status in End-Stage Renal Disease Patients Undergoing Hemodialysis. Ther Apher Dial. 2018 Apr;22(2):118-123. doi: 10.1111/1744-9987.12610. Epub 2017 Dec 7. PMID: 29214734.
  28. Gutiérrez OM, Januzzi JL, Isakova T, Laliberte K, Smith K, Collerone G, Sarwar A, Hoffmann U, Coglianese E, Christenson R, Wang TJ, deFilippi C, Wolf M. Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease. Circulation. 2009 May 19;119(19):2545-52. doi: 10.1161/CIRCULATIONAHA.108.844506. Epub 2009 May 4. PMID: 19414634; PMCID: PMC2740903.
  29. Kirkpantur A. Serum fibroblast growth factor-23 (FGF-23) levels are independently associated with left ventricular mass and myocardial performance index in maintenance haemodialysis patients. Nephrol. Dial. Transplant.
  30. Josipa R. Is There Differences in Cognitive and Motor Functioning between Hemodialysis and Peritoneal Dialysis Patients? Renal Failure.
  31. Wolcott DL, Wellisch DK, Marsh JT, Schaeffer J, Landsverk J, Nissenson AR. Relationship of dialysis modality and other factors to cognitive function in chronic dialysis patients. Am J Kidney Dis. 1988 Oct;12(4):275-84. doi: 10.1016/s0272-6386(88)80220-8. PMID: 3177371.
  32. Buoncristiani U, Alberti A, Gubbiotti G, Mazzotta G, Gallai V, Quintaliani G, Gaburri M. Better preservation of cognitive faculty in continuous ambulatory peritoneal dialysis. Perit Dial Int. 1993;13 Suppl 2:S202-5. PMID: 8399566.
  33. Tilki HE, Akpolat T, Tunali G, Kara A, Onar MK. Effects of haemodialysis and continuous ambulatory peritoneal dialysis on P300 cognitive potentials in uraemic patients. Ups J Med Sci. 2004;109(1):43-8. doi: 10.3109/2000-1967-109. PMID: 15124952.
  34. Kutlay S, Nergizoglu G, Duman N, Atli T, Keven K, Ertürk S, Ates K, Karatan O. Recognition of neurocognitive dysfunction in chronic hemodialysis patients. Ren Fail. 2001 Nov;23(6):781-7. doi: 10.1081/jdi-100108189. PMID: 11777317.
  35. Sithinamsuwan P, Niyasom S, Nidhinandana S, Supasyndh O. Dementia and depression in end stage renal disease: comparison between hemodialysis and continuous ambulatory peritoneal dialysis. J Med Assoc Thai. 2005 Nov;88 Suppl 3:S141-7. PMID: 16858952.
  36. Lai S, Mecarelli O, Pulitano P, Romanello R, Davi L, Zarabla A, Mariotti A, Carta M, Tasso G, Poli L, Mitterhofer AP, Testorio M, Frassetti N, Aceto P, Galani A, Lai C. Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy. Medicine (Baltimore). 2016 Nov;95(48):e5191. doi: 10.1097/MD.0000000000005191. PMID: 27902586; PMCID: PMC5134816.
  37. Lambert K, Mullan J, Mansfield K, Lonergan M. Comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: A cross-sectional study from Australia. Nephrology (Carlton). 2017 Nov;22(11):899-906. doi: 10.1111/nep.12892. PMID: 27505310.
  38. Neumann D, Robinski M, Mau W, Girndt M. Cognitive Testing in Patients with CKD: The Problem of Missing Cases. Clin J Am Soc Nephrol. 2017 Mar 7;12(3):391-398. doi: 10.2215/CJN.03670316. Epub 2017 Feb 1. PMID: 28148556; PMCID: PMC5338701.
  39. Iyasere O, Okai D, Brown E. Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making. Clin Kidney J. 2017 Feb;10(1):89-94. doi: 10.1093/ckj/sfw128. Epub 2017 Jan 7. PMID: 28638609; PMCID: PMC5469575.
  40. Neumann D, Mau W, Wienke A, Girndt M. Peritoneal dialysis is associated with better cognitive function than hemodialysis over a one-year course. Kidney Int. 2018 Feb;93(2):430-438. doi: 10.1016/j.kint.2017.07.022. Epub 2017 Oct 14. PMID: 29042081.
  41. Tian X, Guo X, Xia X, Yu H, Li X, Jiang A. The comparison of cognitive function and risk of dementia in CKD patients under peritoneal dialysis and hemodialysis: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2019 Feb;98(6):e14390. doi: 10.1097/MD.0000000000014390. PMID: 30732180; PMCID: PMC6380759.
  42. Zsom L, Zsom M, Fulop T, Flessner MF. Treatment time, chronic inflammation, and hemodynamic stability: the overlooked parameters in hemodialysis quantification. Semin Dial. 2008 Sep-Oct;21(5):395-400. doi: 10.1111/j.1525-139X.2008.00488.x. PMID: 18945325.
  43. Zsom L, Zsom M, Abdul Salim S, Fülöp T. Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice. Artif Organs. 2020 Oct;44(10):1021-1030. doi: 10.1111/aor.13762. Epub 2020 Jul 27. PMID: 33617092.
  44. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000 Apr 19;283(15):2008-12. doi: 10.1001/jama.283.15.2008. PMID: 10789670.
  45. Li Y, Pi HC, Yang ZK, Dong J. Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis. J Nephrol. 2019.
  46. Levendoğlu F, Altintepe L, Okudan N, Uğurlu H, Gökbel H, Tonbul Z, Güney I, Türk S. A twelve-week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients. J Nephrol. 2004 Nov-Dec;17(6):826-32. PMID: 15593058.

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