Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis

Chunyan Yi,Peiyi Cao,Rui Yang,Xiao Yang,Shuchao Lu,Jianxiong Lin,Jingjing Chen,Ting Zhou,Xueqing Yu

doi:10.1038/s41598-018-35548-4

Chunyan Yi, Peiyi Cao + Show 7 more

Open Access

https://doi.org/10.1038/s41598-018-35548-4

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Journal: Scientific Reports	Publication Date: Nov 23, 2018
Citations: 20	License type: open-access

Affiliation: Sun Yat-sen University

Abstract

The aim of this study was to investigate the prevalence of coexisting frailty and cognitive impairment and its association with clinical outcomes in patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD started to enroll from 2014 to 2016 and ended follow-up by 2017. Frailty was assessed by clinical frailty scale (CFS), and cognitive function was assessed by Montreal Cognitive Assessment (MoCA). Totally 784 CAPD patients were recruited, with median duration of PD 30.7 (8.9~54.3) months. The mean age was 48.8 ± 14.6 years, 320 (40.8%) patients were female and 130 (16.6%) had diabetic nephropathy. Patients with cognitive impairment were more than those with frailty (55.5% vs. 27.6%). Coexisting frailty and cognitive impairment was present in 23.9% patients. Pathway analysis showed that CFS score was negatively associated with MoCA score (β = −0.69, P < 0.001). Coexisting frailty and cognitive impairment was associated with decreased patient survival rate (Log-rank = 84.33, P < 0.001) and increased peritonitis rate (0.22 vs. 0.11, 0.15 and 0.12 episodes per patient year, respectively; all P < 0.001). It was concluded that there was a relatively high prevalence of coexisting frailty and cognitive impairment among patients on CAPD. Frailty was positively associated with cognitive impairment. Coexisting frailty and cognitive impairment increased the risk of adverse outcomes.

Highlights

Coexisting frailty and cognitive impairment group had older age, higher proportion of diabetes mellitus and cardiovascular disease, higher level of high-sensitivity C-reactive protein, lower level of serum albumin, serum phosphorus and blood urea nitrogen compared with those patients without frailty or cognitive impairment and with single cognitive impairment
This group had higher proportion of female, longer duration of dialysis, higher body mass index and total cholesterol compared with without frailty or cognitive impairment group; had higher level of total cholesterol and measured glomerular filtration rate compared with single frailty group; had higher level of triglycerides compared with single cognitive impairment group
A Poisson analysis showed that the peritonitis rate in the coexisting frailty and cognitive impairment group was higher than that in the other three groups (0.22 vs. 0.11, 0.15 and 0.12 episodes per patient year, respectively; all P < 0.001). This prospective cohort study demonstrated that 23.9% of patients on continuous ambulatory peritoneal dialysis (CAPD) presented with coexisting frailty and cognitive impairment