Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients.
Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients.
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DOI：
10.1053/j.ajkd.2016.11.015
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Sarnak MJ
中科院分区：
文献类型：
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作者：
Drew DA;Weiner DE;Tighiouart H;Duncan S;Gupta A;Scott T;Sarnak MJ
认知障碍在接受血液透析治疗的患者中很常见。在这一人群中，认知功能的轨迹和认知能力下降的风险因素仍然不确定。纵向队列：314例血液透析患者，年龄、性别、种族、教育水平、血液透析年份、终末期肾病病因和基线心血管疾病（CVD）史。认知功能通过综合神经认知成套测试确定，在基线时和尽可能每年进行一次。使用主成分分析将个体认知测试结果简化为两个领域的分数，代表记忆和执行功能，它们被用作我们的共同主要结果，并且根据定义，平均值为零，标准差为1。平均年龄为63岁; 54%为男性，22%为黑人，90%至少受过高中教育。在中位随访2.1（IQR，0.9-4.2）年期间，196人至少进行了一次随访检查，156人死亡，43人接受了肾移植。线性混合模型和联合模型解释了死亡、辍学或肾移植的竞争风险，显示出几乎相同的结果。关节模型显示执行功能下降（每年-0.09 [95%置信区间，-0.13至0.05] SD），而记忆力略有改善（每年0.05 [95% CI，0.02至0.08] SD）。简易精神状态检查也出现了显著的年度下降（中位数变化为-0.41; 95%CI，-0.57至-0.25）。年龄较大是执行功能急剧下降的唯一显著风险因素（-0.04 [95% CI，-0.06至-0.02] SD每10岁的年下降更大）。仅限血液透析患者，由于死亡率高，随访测试有限，并排除了患有严重认知缺陷或痴呆的受试者。血液透析患者表现出显著的认知下降，特别是在执行功能测试中。年龄较大是认知能力下降的唯一统计学显著风险因素，这可能对患者管理和教育具有重要的临床后果。未来的研究应该评估维持或改善认知功能的策略。
Cognitive impairment is common in patients treated with hemodialysis. The trajectory of cognitive function and risk factors for cognitive decline remain uncertain in this population. Longitudinal cohort Three hundred fourteen prevalent hemodialysis patients Age, sex, race, education level, hemodialysis vintage, cause of end-stage renal disease, and baseline history of cardiovascular disease (CVD). Cognitive function as determined by a comprehensive neurocognitive battery, administered at baseline and yearly whenever possible. Individual cognitive test results were reduced into two domain scores using principal components analysis, representing memory and executive function, which were used as our co-primary outcomes, and by definition have a mean of zero and standard deviation of one. Mean age was 63 years; 54% were men, 22% were black and 90% had at least a high school education. During median follow up of 2.1 (IQR, 0.9–4.2) years, 196 had at least one follow up test, 156 died and 43 received a kidney transplant. Linear mixed models and joint models, which accounted for competing risks from death, dropout, or kidney transplantation, showed nearly identical results. The joint model demonstrated a decline in executive function (−0.09 [95% confidence interval, −0.13 to −0.05] SD per year), while memory improved slightly (0.05 [95% CI, 0.02 to 0.08] SD per year). A significant yearly decline was also seen in the Mini-Mental State Examination (median change of −0.41; 95% CI, −0.57 to −0.25). Older age was the only significant risk factor for steeper executive function decline (−0.04 [95% CI, −0.06 to −0.02] SD steeper annual decline for each 10 years of age). Prevalent hemodialysis patients only, limited follow up testing due to high mortality rate, and exclusion of participants with severe cognitive deficits or dementia Prevalent hemodialysis patients demonstrate significant cognitive decline, particularly within tests of executive function. Older age was the only statistically significant risk factor for steeper cognitive decline, which may have important clinical consequences for patient management and education. Future studies should evaluate strategies to maintain or improve cognitive function.