Cognitive Impairment, Chronic Kidney Disease, and 1-Year Mortality in Older Patients Discharged from Acute Care Hospital.

Mirko Di Rosa,Maddalena Ricci,Andrea Corsonello,Sonia D’Alia,Luca Soraci,Francesco Guarasci,Antonio Cherubini,Elisa Pierpaoli,Stefano Volpato,Carmelinda Ruggiero,Federica Lenci,Fabrizia Lattanzio,Graziano Onder

doi:10.3390/jcm9072202

Abstract

The prognostic interaction between chronic kidney disease (CKD) and cognitive impairment is still to be elucidated. We investigated the potential interaction of overall cognitive impairment or defective constructional praxis and CKD in predicting 1-year mortality among 646 older patients discharged from hospital. The estimated glomerular filtration rate (eGFR) was calculated using the Berlin Initiative Study (BIS) equation. Cognitive impairment was assessed by the Mini Mental State Exam (MMSE) and defective constructional praxis was ascertained by the inherent MMSE item. The study outcome was 1-year mortality. Statistical analysis was carried out using Cox regression. After adjusting for potential confounders, the co-occurrence of eGFR <30 and overall cognitive impairment (Hazard Ratio (HR) = 3.12, 95% Confidence Interval (CI) = 1.26–7.77) and defective constructional praxis (HR = 2.50, 95% CI = 1.08–5.77) were associated with the outcome. No significant prognostic interaction of eGFR < 30 with either overall cognitive impairment (HR = 1.99, 95% CI = 0.38–10.3) or constructional apraxia (HR = 1.68, 95% CI = 0.33–8.50) was detectable, while only cognitive deficits were found significantly associated with the outcome in the interaction models (HR = 3.12, 95% CI = 1.45–6.71 for overall cognitive impairment and HR = 2.16, 95% CI = 1.05–4.45 for constructional apraxia). Overall cognitive impairment and defective constructional praxis may be associated with increased risk of 1-year mortality among older hospitalized patients with severe CKD. However, no significant prognostic interaction between CKD and cognitive impairment could be observed.

Highlights

Chronic kidney disease (CKD) is known to be associated with relevant morbidity and mortality burden, especially among older people [1]
Overall burden of comorbidity and polypharmacy was higher among patients who died, as was the prevalence of Basic Activity of Daily Living (BADL) dependency, dementia, coronary artery disease, heart failure, and anemia
The prevalence of estimated glomerular filtration rate (eGFR)

Summary

Introduction

Chronic kidney disease (CKD) is known to be associated with relevant morbidity and mortality burden, especially among older people [1]. CKD has formerly emerged as a potential risk factor for cognitive impairment and dementia [4], and several pathways may underly such association. Diabetes and hypertension (the two most common causes of renal disease) have been shown to be synergistically related to cognitive impairment [5]. Decreased glomerular filtration rate, polypharmacy, inflammation, anemia, oxidative stress, and renal replacement therapy (RRT) are among the risk factors likely contributing to cognitive dysfunction in CKD [6]. Current data regarding the cross-sectional association between CKD and cognitive impairment are conflicting. Several cross-sectional studies have reported a high prevalence of cognitive impairment among CKD patients compared to those with preserved kidney function [7]. Cognitive impairment was found to be cross-sectionally associated with both mild–moderate and severe CKD [8,9]. Cognitive disorders are currently considered among negative outcomes of CKD [13], and several longitudinal studies confirm this view [7,14,15]

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Discussion

Conclusion