Cognitive Impairment and 7-Year Mortality in Dialysis Patients
Cognitive Impairment and 7-Year Mortality in Dialysis Patients
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DOI：
10.1053/j.ajkd.2010.07.003
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发表时间：
2010-10-01
影响因子：
13.2
通讯作者：
Newman, Stanton P.
中科院分区：
文献类型：
--
作者：
Griva, Konstadina;Stygall, Jan;Newman, Stanton P.
背景：虽然痴呆症已经预测了大量透析队列中的死亡率，但对终末期肾病患者中不太明显的认知缺陷与死亡率之间的关系知之甚少。这项研究评估了在控制了其他危险因素后，非痴呆性认知障碍是否是透析患者7年生存的独立预测因素。研究设计：前瞻性单队列研究。背景与参与者：来自英国伦敦2个病房的145名普遍存在的透析患者接受了64.3+/-27.4个月的随访，并在改变治疗方法时进行了审查。预测因素：认知障碍，定义为在评估注意力/注意力、记忆和精神运动功能领域的神经认知电池内的2项或更多认知测试中，表现标准差小于标准值的1项。还获得了抑郁、生活质量和临床测量。结果和测量：全因死亡率是主要结果。使用COX比例风险模型评估人口统计学、临床和心理测量以及认知损害对死亡率的贡献。结果：98例(67.6%)患者在基线时存在认知损害。随访时，56例(38.6%)患者死亡，29例死于心脏原因。未经调整的卡普兰-迈耶分析显示，认知受损患者的死亡率较高，7年存活率为49%，而无认知受损患者的7年生存率为83.2%(P<；0.001)。在控制社会人口学、临床和心理因素的调整分析中，与认知障碍相关的死亡风险仍然显著(调整后的HR，2.53；95%CI，1.03-6.22；P=0.04)。限制：样本量和事件数量。结论：认知障碍是透析患者死亡率的独立预测因素。尽管认知障碍的早期识别和治疗对临床结果的影响尚不清楚，但这些结果表明，患者管理方案除了管理共存的医疗条件外，还应努力确保预防认知功能下降。Am J肾脏Dis 56：693-703.(C)2010年，由国家肾脏基金会公司提供。
Background: Although dementia has predicted mortality in large dialysis cohorts, little is known about the relationship between less pronounced cognitive deficits and mortality in patients with end-stage renal disease. This study assessed whether cognitive impairment without dementia was an independent predictor of 7-year survival in dialysis patients after controlling for other risk factors.Study Design: Prospective single-cohort study.Setting & Participants: 145 prevalent dialysis patients from 2 units in London, UK, were followed up for 64.3 +/- 27.4 months and censored at the time of change to a different treatment.Predictors: Cognitive impairment, defined as performance 1 standard deviation less than normative values on 2 or more cognitive tests within a neurocognitive battery assessing attention/concentration, memory, and psychomotor function domains. Depression, quality-of-life, and clinical measures also were obtained.Outcomes & Measurements: All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical and psychological measures and cognitive impairment to mortality.Results: 98 (67.6%) patients were cognitively impaired at baseline. At follow-up, 56 (38.6%) patients had died, 29 of cardiac causes. Unadjusted Kaplan-Meier analysis showed higher mortality in cognitively impaired patients, in whom 7-year survival was 49% versus 83.2% in those with no cognitive impairment (P < 0.001). Mortality risk associated with cognitive impairment remained significant in adjusted analysis controlling for sociodemographic, clinical, and psychological factors (adjusted HR, 2.53; 95% CI, 1.03-6.22; P = 0.04).Limitations: Small sample size and number of events.Conclusions: Cognitive impairment is an independent predictor of mortality in dialysis patients. Although the implications of early recognition and treatment of cognitive impairment for clinical outcomes are unclear, these results suggest that patient management protocols should attempt to ensure prevention of cognitive decline in addition to managing coexisting medical conditions. Am J Kidney Dis 56: 693-703. (C) 2010 by the National Kidney Foundation, Inc.