CHANGES IN COGNITIVE FUNCTION IN PATIENTS WITH END-STAGE KIDNEY DISEASE ON DIALYSIS AND THE EFFECT OF DIALYSIS VINTAGE

Murali K1,2, Mullan J2, Roodenrys S2, Cheikh Hassan H1,2, Lonergan M1,2

1Wollongong Hospital, Wollongong, Australia, 2University of Wollongong, Wollongong, Australia

Aim: Evaluate cognitive function (CF) trend in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) on dialysis.

Background: Impaired CF is common in CKD and ESKD patients. CF trends in this population are less well known.

Methods: In a cohort of non-dialysis CKD and dialysis patients, CF assessed using modified mini-mental state examination (3MS), trail-making tests (TMT) A&B and Stroop task and depression assessed using Beck depression inventory 2 (BDI2) at baseline and > 1year after baseline.  Demographics and comorbidities assessed at baseline. Change scores in CF and depression compared between ESKD/ CKD groups. Among ESKD, change scores compared between patients with dialysis vintage of ≤1-year versus >1-year. Analysis of covariance (ANCOA) used to adjust effect of age on change scores.

Results:  Mean age of study population (N=211) was 66.9±11.2years. Baseline 3MS and TMT-A&B, and depression scores were significantly worse in ESKD (N=103) compared to CKD (N=108).  Patients discontining after baseline assessment (N=51) had worse CF scores suggesting differential attrition.   ANCOVA adjusting for age in followed-up patients (N=160) showed significant improvement in 3MS scores (F(1,157)=6.65,p=0.011), mainly  the memory subscale, in ESKD patients, while TMT A&B and BDI2 scores showed no significant change. Among ESKD patients, significant improvement in 3MS scores (F(1,67)=7.95,p=0.006), mainly memory subscale noted in patients with dialysis vintage ≤1-year compared to >1-year.

Conclusion: Though baseline cognitive function was worse in ESKD patients compared to CKD, their CF scores, especially memory improved on follow-up, which was significant only in patients who have been on dialysis for less than one-year. This may indicate an early beneficial effect from clearance of uraemic neurotoxins. Differential attrition of study subjects may have impacted the results.


Biography:

Dr. Karumathil Murali is a senior nephrologist in Wollongong hospital and is a clinical associate professor in University of Wollongong.

He is actively involved in teaching medical students, junior medical officers and advanced trainees.

His field of research includes the impact of health literacy and cognitive function on treatment adherence and strategies to improve treatment adherence in patients with kidney disease including dialysis patients.

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