Quality of life and cognitive assessment in healthy older Asian people with early and moderate chronic kidney disease: The NAHSIT 2013-2016 and validation study.

Sheng-Feng Lin,Wen-Harn Pan,Yen-Chun Fan,Tzu-Tung Kuo,Chyi-Huey Bai,Abduzhappar Gaipov

doi:10.1371/journal.pone.0264915

Abstract

Taiwan has the highest prevalence of chronic kidney disease (CKD). Impaired cognition and quality of life are significant phenomena in the late stages of CKD. We sought to obtain an overview and the attributable effect of impaired glomerular filtration on multiple domains in cognition and dimensions of quality of life for community-based healthy older adults in Taiwan. The study was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016, a nationwide cross-sectional study conducted to sample healthy, community-based older adults aged ≥65 years in Taiwan. Participants were categorized into four CKD groups: CKD stage 1, stage 2, stages 3a and 3b, and stages 4-5. The Mini-Mental State Examination (MMSE) and the QoL questionnaire derived from the 12-item Short Form Health Survey (SF-12) were measured. Generalized linear mixed models (GLMMs) and principal component regressions were employed for the analysis and validation, respectively. Participants with moderate CKD (stages 3a and 3b) showed deficits in global MMSE, domain orientation to time, calculation, complex commands, and role-physical and vitality in QoL questionnaires. In GLMMs, impaired eGFR per 30 mL/min/1.73 m² was associated with lower global MMSE scores (β = -0.807, standard error [SE] = 0.235, P = 0.0007), domain orientation to time (β = -0.155, SE = 0.047, P = 0.0011), calculation (β = -0.338, SE = 0.109, P = 0.0020), complex commands (β = -0.156, SE = 0.079, P = 0.0494), and role-physical (β = -2.219, SE = 0.779, P = 0.0046) dimensions of QoL. Elderly Han Chinese adults with moderately impaired renal filtration could manifest cognitive deficits in orientation to time, calculation, and impaired quality of life in physical role functioning.

Highlights

High prevalence of chronic kidney disease in TaiwanIn Taiwan, the incidence rate and prevalence throughout all stages of kidney disease were approximately 27,210 per million person-years and 154,600 per million people in the last decade [1]
In Generalized linear mixed models (GLMMs), impaired estimated glomerular filtration rate (eGFR) per 30 mL/min/1.73 m2 was associated with lower global Mini-Mental State Examination (MMSE) scores (β = -0.807, standard error [SE] = 0.235, P = 0.0007), domain orientation to time (β = -0.155, SE = 0.047, P = 0.0011), calculation (β = -0.338, SE = 0.109, P = 0.0020), complex commands (β = -0.156, SE = 0.079, P = 0.0494), and rolephysical (β = -2.219, SE = 0.779, P = 0.0046) dimensions of QoL
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Summary

Introduction

In Taiwan, the incidence rate and prevalence throughout all stages of kidney disease were approximately 27,210 per million person-years and 154,600 per million people in the last decade [1]. The USRDS in 2020 [2] reported that the prevalence of ESRD is highest in the age group of 45–64 years (25,156 per million population), compared to 20–44 years (5,290 per million population), 65–74 years (17,194 per million population), 75 years (15,066 per million population). Renal disease is assessed by the degree of injured kidney filtration rate [8, 9], and CKD is relatively asymptomatic until the end stage [10]. Taiwan has the highest prevalence of chronic kidney disease (CKD).

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Conclusion