Cognitive Impairment in Non-Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
Cognitive Impairment in Non-Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
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DOI：
10.1053/j.ajkd.2018.02.361
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
CRIC Study Investigators
中科院分区：
文献类型：
--
作者：
Harhay MN;Xie D;Zhang X;Hsu CY;Vittinghoff E;Go AS;Sozio SM;Blumenthal J;Seliger S;Chen J;Deo R;Dobre M;Akkina S;Reese PP;Lash JP;Yaffe K;Kurella Tamura M;CRIC Study Investigators
晚期慢性肾脏疾病（CKD）与认知障碍风险升高相关。然而，目前尚不清楚认知障碍是否以及如何与终末期肾脏疾病的计划和准备相关。回顾性观察性研究。630名参加CRIC（慢性肾功能不全队列）研究的成年人在晚期CKD中进行认知评估，定义为肾小球滤过率（eGFR）估计≤20 ml/min/1.73m2，随后开始维护性透析。透析前认知障碍，定义为修改后的迷你精神状态检查得分低于先前得出的基于年龄的阈值得分。协变量包括年龄、种族/民族、受教育程度、合并症和健康素养。腹膜透析（PD）作为第一透析方式，先发制人的永久通道放置，透析开始时静脉导管避免，以及肾移植的先发制人等待名单。多变量调整逻辑回归。117名参与者（19%）存在透析前认知障碍。在16%的参与者（n=100）中，PD是第一种透析方式，75%的参与者（n=473）预先放置了静脉导管，45%的参与者（n=279）在透析开始时避免使用静脉导管，20%的参与者（n=126）预先等待。透析前认知障碍与PD作为第一种透析方式的可能性降低78%（校正优势比[aOR]， 0.22； 95%可信区间[CI]， 0.06-0.74; p=0.02）和透析开始时静脉导管避免的可能性降低42% （aOR, 0.58; 95% CI, 0.34-0.98; p=0.04）独立相关。透析前的认知障碍与预先的永久通道安置或等待名单没有独立的关联。潜在的无法测量的混杂因素；认知功能的单一测量。透析前认知障碍与PD作为第一透析方式的可能性较低以及透析开始时静脉导管避免的可能性有关。未来的研究可能会考虑在测试策略时解决认知功能问题，以改善患者向透析的过渡。
Advanced chronic kidney disease (CKD) is associated with an elevated risk of cognitive impairment. However, it is not known if 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 an estimated glomerular filtration rate (eGFR) ≤ 20 ml/min/1.73m2, and subsequently initiated maintenance dialysis. Pre-dialysis cognitive impairment, defined as a score on the Modified Mini-Mental State Examination below 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, pre-emptive permanent access placement, venous catheter avoidance at dialysis initiation, and pre-emptive wait-listing for kidney transplantation. Multivariable-adjusted logistic regression. Pre-dialysis cognitive impairment was present in 117 participants (19%). PD was the first dialysis modality among 16% of participants (n=100), 75% had pre-emptive access placed (n=473), 45% avoided using a venous catheter at dialysis initiation (n=279), and 20% were pre-emptively wait-listed (n=126). Pre-dialysis cognitive impairment was independently associated with an 78% lower odds of PD as the first dialysis modality (adjusted Odds Ratio [aOR], 0.22; 95% Confidence Interval [CI], 0.06–0.74; p=0.02) and a 42% lower odds of venous catheter avoidance at dialysis initiation (aOR, 0.58; 95% CI, 0.34–0.98; p=0.04). Pre-dialysis cognitive impairment was not independently associated with pre-emptive permanent access placement or wait-listing. Potential unmeasured confounders; single measure of cognitive function. Pre-dialysis cognitive impairment is associated with a lower likelihood of PD as a first dialysis modality and of venous catheter avoidance at dialysis initiation. Future studies may consider addressing cognitive function when testing strategies to improve patient transitions to dialysis.
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作者：
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