scholarly journals Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252237
Author(s):  
Karumathil M. Murali ◽  
Judy Mullan ◽  
Steven Roodenrys ◽  
Hicham I. Cheikh Hassan ◽  
Maureen Lonergan
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Analysis Of Covariance ◽  
End Stage Kidney Disease ◽  
Change Scores ◽  
Dialysis Vintage ◽  
One Year ◽  
End Stage

Introduction Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. Methods We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression ≥ 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of <1-year and >1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. Results At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage <1-year compared to >1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Conclusion Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.

scholarly journals Dietary Factors and Prevention: Risk of End-Stage Kidney Disease by Fruit and Vegetable Consumption

2021 ◽  
pp. 1-12
Author(s):  
Tanushree Banerjee ◽  
Juan Jesus Carrero ◽  
Charles McCulloch ◽  
Nilka Rios Burrows ◽  
Karen R. Siegel ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Risk Model ◽  
Vegetable Consumption ◽  
Dietary Factors ◽  
Inverse Association ◽  
Fruit And Vegetable ◽  
End Stage Kidney Disease ◽  
Strong Inverse Association ◽  
End Stage

<b><i>Background:</i></b> The association between fruit and vegetable (FV) intake and the risk of end-stage kidney disease (ESKD) has not been examined in the general population and fully explored in chronic kidney disease (CKD). We prospectively evaluated this relationship in US representative sample of adults and evaluated consistency by the presence or absence, and severity, of CKD. <b><i>Methods:</i></b> We used data from the Third National Health and Nutrition Examination Survey (1988–1994) linked with the US Renal Data System, including 14,725 adults aged ≥20 years and with follow-up for ESKD through 2008. Daily FV intake was ascertained using a food frequency questionnaire. We examined the association between selected categories of FV intake and ESKD using a Fine Gray competing risk model adjusting for sociodemographics, lifestyle, clinical and nutritional factors, estimated glomerular filtration rate, and albuminuria. We evaluated whether risk varied in individuals with severe versus any CKD. <b><i>Results:</i></b> 230 participants (1.5%) developed ESKD during follow-up. In the adjusted model, compared to highest intake, those in lowest categories of FV intake had a higher risk of ESKD, for &#x3c;2 times/day (1.45 [1.24–1.68], 2 to &#x3c;3 times/day (1.40 [1.18–1.61]), 3 to &#x3c;4 times/day (1.25 [1.04–1.46]), and 4 to &#x3c;6 times/day (1.14 [0.97–1.31]). There was suggestion of heterogeneity (<i>p</i> for interaction = 0.03) with possible stronger inverse association in patients with CKD than those without CKD. After stratification, we obtained similar strong inverse association when we examined ESKD incidence across intake of FVs in participants with CKD stages 1–4 (<i>n</i> = 5,346) and specifically in those with CKD stages 3–4 (<i>n</i> = 1,084). <b><i>Conclusions:</i></b> Low intake of FVs was associated with higher risk of ESKD in US adults with and without CKD, supporting an emerging body of literature on the potential benefits of plant-rich diets for prevention of ESKD.

End-stage kidney disease on dialysis: an observational study of modality change from maximum conservative management

2021 ◽  
pp. bmjspcare-2020-002839
Author(s):  
Alvin Shrestha ◽  
Aine Burns
Keyword(s):  
Kidney Disease ◽  
Conservative Management ◽  
Fluid Overload ◽  
Common Symptom ◽  
End Stage Kidney Disease ◽  
Kaplan Meier ◽  
Comorbidity Index ◽  
Poor Outcomes ◽  
One Year ◽  
End Stage

ObjectivesA rising burden from end-stage kidney disease with poor outcomes in the frail, elderly population has seen the emergence of a non-dialytic option, also known as maximum conservative management (MCM). Despite an established MCM programme in our institution, it was anecdotally observed that some MCM patients would end up being dialysed short and long term. We explored treatment modality changes from MCM to renal replacement therapy (RRT), the reasons surrounding the change, and aimed to quantify survival in this cohort of patients.Methods44 patients were identified as being MCM, who changed modalities to RRT, from 2000 to 2015, using the Royal Free Hospital Renal Unit’s database. Electronic health records were reviewed retrospectively. Associations with 12-month mortality were explored and Kaplan-Meier method used to predict survival.ResultsThe most common modality change was to haemodialysis (81%), with one transplantation, and rest peritoneal dialysis. 28 patients commenced dialysis as unplanned starters, with the most common symptom being fluid overload. One-year survival was associated with increased age (75 vs 83, p=0.004, for alive vs dead) and had lower mean Charlson Comorbidity Index (6.2 vs 7.3, p=0.021). Median survival of 65 months following RRT initiation was predicted by the Kaplan-Meier method.ConclusionsPatients changed modalities from MCM to RRT due to symptoms, the most common being fluid overload. Despite an unplanned change to RRT, survival appears to be significant at 65 months in this study, indicating clinicians are continuing to offer RRT to patients appropriately.

scholarly journals P0796THE PREVALENCE AND INCIDENCE OF COGNITIVE IMPAIRMENT IN A COHORT OF CHRONIC KIDNEY DISEASE PATIENTS WITH CONCOMITANT DIABETES ATTENDING A SPECIALIST NEPHROLOGY CLINIC

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mick Kumwenda ◽  
Peter Hobson
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Incidence Rate ◽  
Neuropsychological Assessment ◽  
Current Investigation ◽  
Dsm 5 ◽  
Crude Prevalence

Abstract Background and Aims Chronic kidney disease (CKD) is a global healthcare problem associated with several comorbid conditions including, cardiovascular disease, and diabetes, all of which are strong risk factors for the development of significant cognitive impairment. We recently reported the baseline outcomes of our older adult cohort with mild to moderate CKD (stages 3-4) and diabetes, where 48% were found to have a cognitive impairment ranging from mild to severe symptoms. [1] This study reports the outcomes at 36-months post baseline of the prevalence and incidence of cognitive impairment in this cohort the patients who at baseline were considered to have normal cognitive function. Method Cognitive function was assessed in patients over aged 55 years, with an estimated glomerular filtration rate &lt; 45ml/min/1.73m 2, attending a renal and diabetes outpatient clinic, at baseline and at 36-months. The diagnosis of cognitive impairment was based upon patient and informant interview, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental disorders version 5 (DSM-5) and Petersen’s criteria for mild cognitive impairment (MCI). The incidence of cognitive impairment was calculated by dividing the number of new cases during study follow-up, by the person-time at risk throughout the observation period. Since it is not possible to precisely determine when a person actually develops cognitive impairment between baseline and follow-up, the midpoint of time between having normal cognition and becoming a case is assumed. Results Ninety-two patients without cognitive impairment at baseline, were included in this investigation (mean age of 75.8 + 9.1; 49 males: 43 female). Upon neuropsychological assessment and the application of DSM-5 criteria at follow-up, it was revealed that 25/92 (27%) of the cohort had developed a cognitive impairment ranging from MCI (n=19), to major symptoms (n = 6). The crude prevalence for MCI was 20.6%, and for dementia it was 6.5%. The total person years in the study were 237.38 years, with an overall incidence rate of 10.53 (95% Confidence interval 6.82-15.55) per 100 person-years. Conclusion This longitudinal cohort investigation reports the prevalence and incidence of new cases of cognitive impairment ranging from MCI to dementia in CKD. The crude prevalence in the current investigation for the development of cognitive impairment was 27%. The overall incidence rate for new cases of NCD was just over 10%. In other words, for every 100 patients in our current investigation we would estimate that around 10 will develop some a cognitive impairment ranging from MCI to dementia per year. Our findings from this and our previous investigation suggest that a significant number of CKD patients are at risk for the development of significant neurodegenerative conditions and in view of this cognitive function should be screened and monitored routinely in clinical practice. This will assist with appropriate health service planning, service development, clinical interventions and the assessment of the effectiveness of new and existing treatments services.

Increased Inflammatory Response in Association with the Initiation of Hemodialysis Compared with Peritoneal Dialysis in a Prospective Study of End-Stage Kidney Disease Patients

2018 ◽  
Vol 38 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Kenneth Yong ◽  
Gursharan Dogra ◽  
Neil Boudville ◽  
Wai Lim
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Inflammatory Response ◽  
Prospective Study ◽  
End Stage Kidney Disease ◽  
Cvd Risk ◽  
Ckd Stage ◽  
End Stage

Background Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods We per formed a pilot prospective study on 75 predialysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis Results Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.

scholarly journals Metabolic Syndrome Severity Score, Comparable to Serum Creatinine, Could Predict the Occurrence of End-Stage Kidney Disease in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

2021 ◽  
Vol 10 (24) ◽  
pp. 5744
Author(s):  
Pil Gyu Park ◽  
Jung Yoon Pyo ◽  
Sung Soo Ahn ◽  
Jason Jungsik Song ◽  
Yong-Beom Park ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Characteristic Curve ◽  
Antineutrophil Cytoplasmic Antibody ◽  
End Stage Kidney Disease ◽  
The Metabolic Syndrome ◽  
Poor Outcomes ◽  
End Stage

This study investigated whether the metabolic syndrome (MetS) severity (MSSS) at diagnosis could predict poor outcomes during follow-up in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with MetS. The equation for the MSSS at diagnosis used in this study was developed and validated in Korean adults aged 20–59 years. The medical records of 261 patients with AAV were retrospectively reviewed, and finally, 36 AAV patients with MetS aged 20–59 years fulfilling the inclusion criteria were included in this study. All-cause mortality, relapse, end-stage kidney disease (ESKD), cerebrovascular accident, and cardiovascular disease were assessed as the poor outcomes of AAV. Their median age was 51.2 years and 36.1% were male. The MSSS was significantly correlated with age and serum albumin but not AAV-specific indices. Among the five poor outcomes, only ESKD showed a relatively significant area under the curve (area 0.696) in receiver operating characteristic curve analysis. In the multivariable Cox hazards model analysis, both serum creatinine (HR 3.033) and MSSS (HR = 2.221) were significantly associated with ESKD occurrence. When the cut-off of the MSSS for ESKD was set at 1.72, ESKD occurred more frequently in patients with MSSS ≥ 1.72 than in those with MSSS < 1.72 (75.0% versus 14.3%, p = 0.002). Furthermore, patients with MSSS ≥ 1.72 exhibited a significantly lower cumulative ESKD-free survival rate than those with MSSS < 1.72 (p = 0.001). MSSS at the time of AAV diagnosis independently predicted the occurrence of ESKD during follow-up in patients with AAV and MetS.

scholarly journals Sickle Cell Trait and Risk of Cognitive Impairment in African Americans: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1322-1322 ◽  
Author(s):  
Christina Cahill ◽  
Marguerite Ryan Irvin ◽  
Neil A Zakai ◽  
Rakhi P. Naik ◽  
Leslie McClure ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
African Americans ◽  
Kidney Disease ◽  
Racial Differences ◽  
Odds Ratio ◽  
Sickle Cell Trait ◽  
Function Testing

Abstract Background:Sickle cell anemia (SCA) has been associated with cognitive dysfunction, perhaps in part due to vascular occlusive disease. Increasing evidence suggests that some complications of SCA might also affect those with sickle cell trait (SCT), including chronic and end-stage kidney disease and venous thromboembolism. Thus, SCT may not be a benign condition. Based on data that SCA may influence cognition, we hypothesized that SCT is a risk factor for cognitive impairment in African-Americans. Methods: Participants were African-American adults aged 45 and older from a national prospective cohort study of 30,239 white and black Americans; the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The study collected extensive baseline risk factor data, and conducted baseline and annual cognitive function testing using the Six-Item Screener (SIS), a validated telephone-administered instrument for global cognitive function that yields a score from 0 to 6. Participants included in this analysis were African-Americans without SCA who had available data on baseline and at least one follow up SIS, SCT genotyping and principal components of ancestry. Participants with baseline SIS ≤4 were excluded as having prevalent impairment. Incident cognitive impairment was defined as having a score at the most recent assessment of ≤4. Logistic regression was used to model associations of SCT with incident cognitive impairment, adjusted for risk factors (listed in table footnote). Results:Among 5,507 participants (mean age 63.5), 731 developed incident cognitive impairment with average follow up of 8.1 years. Those with incident cognitive impairment were more likely to be male with prebaseline history of cardiovascular diseases, diabetes, hypertension and dyslipidemia, and had lower income and education. They were slightly more likely to have SCT (7.9% vs 7.3%). In sequentially adjusted models (table), there was no association of SCT with incident cognitive impairment, with a fully adjusted odds ratio of 1.16 (95% CI 0.79-1.71). There were no significant differences in this odds ratio by age, diabetes, hypertension, dyslipidemia, cardiovascular disease, kidney disease or smoking status (p for interaction with SCT all >0.4). Conclusion:In this prospectively followed general population cohort of middle-aged and older adults with longitudinal cognitive function testing, SCT was not associated with increased risk of incident cognitive impairment overall or in various high-risk subgroups. These findings suggest that unlike in SCA, SCT does not result in chronic cerebrovascular dysfunction. To confirm and extend these findings, further work is needed on associations of SCT with specific domains of cognitive function. Disclosures No relevant conflicts of interest to declare.

scholarly journals Relative leucocyte telomere length is associated with incident end-stage kidney disease and rapid decline of kidney function in type 2 diabetes: analysis from the Hong Kong Diabetes Register

Diabetologia ◽  
2021 ◽  
Author(s):  
Feifei Cheng ◽  
Andrea O. Luk ◽  
Hongjiang Wu ◽  
Claudia H. T. Tam ◽  
Cadmon K. P. Lim ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Hong Kong ◽  
Kidney Disease ◽  
Telomere Length ◽  
Rapid Decline ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Diabetes Register

Abstract Aims/hypothesis Few large-scale prospective studies have investigated associations between relative leucocyte telomere length (rLTL) and kidney dysfunction in individuals with type 2 diabetes. We examined relationships between rLTL and incident end-stage kidney disease (ESKD) and the slope of eGFR decline in Chinese individuals with type 2 diabetes. Methods We studied 4085 Chinese individuals with type 2 diabetes observed between 1995 and 2007 in the Hong Kong Diabetes Register with stored baseline DNA and available follow-up data. rLTL was measured using quantitative PCR. ESKD was diagnosed based on the ICD-9 code and eGFR. Results In this cohort (mean ± SD age 54.3 ± 12.6 years) followed up for 14.1 ± 5.3 years, 564 individuals developed incident ESKD and had shorter rLTL at baseline (4.2 ± 1.2 vs 4.7 ± 1.2, p < 0.001) than the non-progressors (n = 3521). On Cox regression analysis, each ∆∆Ct decrease in rLTL was associated with an increased risk of incident ESKD (HR 1.21 [95% CI 1.13, 1.30], p < 0.001); the association remained significant after adjusting for baseline age, sex, HbA1c, lipids, renal function and other risk factors (HR 1.11 [95% CI 1.03, 1.19], p = 0.007). Shorter rLTL at baseline was associated with rapid decline in eGFR (>4% per year) during follow-up (unadjusted OR 1.22 [95% CI 1.15, 1.30], p < 0.001; adjusted OR 1.09 [95% CI 1.01, 1.17], p = 0.024). Conclusions/interpretation rLTL is independently associated with incident ESKD and rapid eGFR loss in individuals with type 2 diabetes. Telomere length may be a useful biomarker for the progression of kidney function and ESKD in type 2 diabetes. Graphical abstract

Follow-up of aspirin-resistant patients with end-stage kidney disease

2012 ◽  
Vol 45 (4) ◽  
pp. 1097-1102 ◽  
Author(s):  
Kadriye Orta Kilickesmez ◽  
Cuneyt Kocas ◽  
Okay Abaci ◽  
Baris Okcun ◽  
Bilal Gorcin ◽  
...  
Keyword(s):  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage
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