Cognitive function and all-cause mortality in maintenance hemodialysis patients.
Cognitive function and all-cause mortality in maintenance hemodialysis patients.
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DOI：
10.1053/j.ajkd.2014.07.009
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
Sarnak MJ
中科院分区：
文献类型：
--
作者：
Drew DA;Weiner DE;Tighiouart H;Scott T;Lou K;Kantor A;Fan L;Strom JA;Singh AK;Sarnak MJ
认知障碍在血液透析患者中很常见，并与显著的发病率相关。关于认知损害是否与生存相关，以及认知损害的类型是否重要，目前存在有限的信息。纵向队列。在基线和每年对292名普遍存在的血液透析患者进行一系列全面的认知测试，评估认知功能。通过主成分分析，将个体测试结果归结为两个领域的分数，分别代表记忆和执行功能。根据定义，每个评分的平均值为0，标准偏差为1。使用根据人口统计学以及透析和心血管(CV)危险因素调整后的COX比例风险模型评估每个评分与全原因死亡率的相关性。参与者的平均年龄为63岁，其中53%为男性，23%为非裔美国人，90%至少受过高中教育。中位随访时间为2.1(IQR，1.1-3.7)年，共发生145例死亡。执行功能评分每提高1-SD，死亡率降低35%(HR，0.65；95%CI，0.55-0.76)。在调整人口统计学和透析相关因素的模型中，这种关系部分减弱，但仍然显著(HR，0.81；95%CI，0.67-0.98)，而调整心血管疾病和心力衰竭后，这种关系进一步减弱(HR，0.87；95%CI，0.72-1.06)。使用时间依赖模型显示了类似的未调整关联(HR，0.62；95%CI，0.54-0.72)，在调整了人口统计学、透析和心血管危险因素后，这种关系仍然显著(HR，0.79；95%CI，0.66-0.94)。在单变量分析中，较好的记忆力与较低的死亡率相关(每1个SD的HR，0.82[95%CI，0.69-0.96])，但在调整人口统计学因素时(HR，1.00；95%CI，0.83-1.19)。痴呆症患者被排除在整个电池之外，可能低估了这种联系的强度。执行功能和记忆力较差与死亡风险增加有关。对于记忆，这种关联可以由患者的人口统计学来解释，而对于执行功能，这种关系可能部分地由心血管疾病负担来解释。
Cognitive impairment is common in hemodialysis patients and associated with significant morbidity. Limited information exists on whether cognitive impairment is associated with survival, and whether type of cognitive impairment is important. Longitudinal cohort. Cognitive function was assessed at baseline and yearly using a comprehensive battery of cognitive tests in 292 prevalent hemodialysis patients. Using principal component analysis, individual test results were reduced into 2 domain scores, representing memory and executive function. By definition, each score carried a mean of 0 and SD of 1. Association of each score with all-cause mortality was assessed using Cox proportional hazards models adjusted for demographics as well as dialysis and cardiovascular (CV) risk factors. Mean age of participants was 63 years, 53% were male, 23% were African American and 90% had at least a high school education. During median follow up of 2.1 (IQR, 1.1–3.7) years, 145 deaths occurred. Each 1-SD better executive function score was associated with 35% lower hazard of mortality (HR, 0.65; 95% CI, 0.55–0.76). In models adjusting for demographics and dialysis-related factors, this relationship was partially attenuated but remained significant (HR, 0.81; 95% CI, 0.67–0.98), while adjustment for CV disease and heart failure further attenuated it (HR, 0.87; 95% CI, 0.72–1.06). Use of time-dependent models showed a similar unadjusted association (HR, 0.62; 95% CI, 0.54–0.72), with the relationship remaining significant after adjustment for demographics, dialysis, and CV risk factors (HR, 0.79; 95% CI, 0.66–0.94). Better memory was associated with lower mortality in univariate analysis (HR per 1 SD, 0.82 [95% CI, 0.69–0.96]), but not when adjusting for demographics (HR, 1.00; 95% CI, 0.83–1.19). Patients with dementia were excluded from the full battery, perhaps underestimating strength of the association. Worse executive function and memory are associated with increased risk of mortality. For memory, this association is explained by patient demographics, while for executive function this relationship may be partly explained by CV disease burden.
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DOI：
10.1053/j.ajkd.2012.08.035
发表时间：
2013-02
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Drew DA;Bhadelia R;Tighiouart H;Novak V;Scott TM;Lou KV;Shaffi K;Weiner DE;Sarnak MJ
通讯作者：
Sarnak MJ
DOI：
10.1053/j.ajkd.2011.03.034
发表时间：
2011-11
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Weiner DE;Scott TM;Giang LM;Agganis BT;Sorensen EP;Tighiouart H;Sarnak MJ
通讯作者：
Sarnak MJ
影响因子：
13.2
作者：
Griva, Konstadina;Stygall, Jan;Newman, Stanton P.
通讯作者：
Newman, Stanton P.
影响因子：
9.9
作者：
Sarnak, Mark J.;Tighiouart, Hocine;Weiner, Daniel E.
通讯作者：
Weiner, Daniel E.
影响因子：
--
作者：
Drew, David A.;Tighiouart, Hocine;Sarnak, Mark J.
通讯作者：
Sarnak, Mark J.