Cognitive impairment, quality of life and healthcare utilization in patients with chronic kidney disease stages 3 to 5.

Abstract

This study aimed to examine associations between cognitive impairment and quality of life and healthcare utilization in patients with chronic kidney disease (CKD) stages 3 to 5. A cross-sectional study was conducted in 379 outpatients with a mean age of 65.7 years at tertiary care hospitals in Thailand. Cognitive function was measured using the Mini-Mental State Examination, and quality of life was measured using the five-dimension European quality of life (EQ-5D-5L) multi-attribute utility instrument. The effects of cognitive impairment on the likelihood of reporting 'no problems' for each EQ-5D dimension, the quality of life scores and healthcare utilization were determined using an appropriate multivariate analysis. The prevalence of cognitive impairment in patients with CKD stages 3 to 5 was 15.8% (95% confidence interval [CI], 12.3, 19.9). Patients with cognitive impairment had a significantly lower likelihood of achieving good outcomes in the mobility, self-care, usual activities and anxiety/depression dimensions of the EQ-5D-5L than those with normal cognition. Patients with cognitive impairment had a significantly lower quality of life score than those with normal cognition by 0.06 points (95% CI, 0.01, 0.10). Cognitive impairment increased the number of emergency visits (rate ratio, RR, 3.47; 95% CI, 1.45, 8.29). Compared to CKD stage 3, CKD stage 5 decreased the quality of life score by 0.06 points (95% CI, 0.01, 0.10) and increased the rate of hospitalization (RR, 2.29; 95% CI, 1.27, 4.12). Cognitive impairment in patients with CKD was associated with lower quality of life scores and increased healthcare utilization.