Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-24T09:36:06.221Z Has data issue: false hasContentIssue false

Neurocognitive Profile of an Adult Sample With Chronic Kidney Disease

Published online by Cambridge University Press:  10 November 2010

Sofia Sánchez-Román*
Affiliation:
National Autonomous University of Mexico, Mexico City, Mexico Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
Feggy Ostrosky-Solís
Affiliation:
National Autonomous University of Mexico, Mexico City, Mexico
Luis E. Morales-Buenrostro
Affiliation:
Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
M.G. Nogués-Vizcaíno
Affiliation:
Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
Josefina Alberú
Affiliation:
Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
Shawn M. McClintock
Affiliation:
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York
*
Correspondence and reprint requests to: Sofía Sánchez-Román, Departamento de Neurología y Psiquiatría, Vasco de Quiroga 15, Tlalpan, Sección XVI, 14000, México D.F. E-mail: [email protected]

Abstract

Chronic kidney disease (CKD) is a common and debilitating illness that impacts neurocognitive function. However, the majority of previous studies varied in methodologic design and rigor, thus minimizing definitive conclusions. The present study was designed to determine the impact of CKD on neurocognitive function through specific examination of CKD factors and therapeutic interventions. We evaluated 120 CKD outpatients and 41 healthy donors (controls) in terms of neurocognitive function, anxiety, and depressive symptomatology, and somnolence. Information regarding medical and treatment history was recorded. Twenty-three percent of CKD patients presented with cognitive impairment. Stage 5 patients had lower scores (p < .05) compared with controls and patients in stage 3 and 4 on measures of global cognitive function. No differences in global cognitive function were found between stage 3 and 4 patients and controls. A greater proportion of patients undergoing hemodialysis relative to those treated with peritoneal dialysis showed impairment on measures of memory functions. Results suggest that stage 5 CKD patients may present with impaired cognitive functions. Anemia appeared to be a key variable that may explain the memory impairment in this sample. Future longitudinal investigations of CKD are warranted to determine the trajectory of cognitive impairment. (JINS, 2010, 17, 000–000)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agnihotri, P., Telfer, M., Butt, Z., Jella, A., Cella, D., Kozma, , Akamah, J. (2007). Chronic anemia and fatigue in elderly patients: Results of a randomized, double-blind, placebo-controlled, crossover exploratory study with epoetin alfa. Journal of the American Geriatrics Society, 55, 15571565.CrossRefGoogle ScholarPubMed
Barzilay, J.I., Fitzpatrick, A.L., Luchsinger, J., Yasar, S., Bernick, C., Jenny, N.S., Kuller, L.H. (2008). Albuminuria and dementia in the elderly: A community study. American Journal of Kidney Diseases, 52, 216226.CrossRefGoogle ScholarPubMed
Buchman, A.S., Tanne, D., Boyle, P.A., Shah, R.C., Leurgans, S.E., Bennett, D.A. (2009). Kidney function is associated with the rate of cognitive decline in the elderly. Neurology, 73, 920927.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). (2007). Prevalence of chronic kidney disease and associated risk factors--United States, 1999-2004. MMWR Morbidity and Mortality Weekly Report, 56, 161165. Retrieved from http://www.cdc.gov/Google Scholar
Chamney, M., Pugh-Clarke, K., Kafkia, T. (2009). Management of co-morbid diseases in a patient with established renal failure. Journal of Renal Care, 35, 151158.CrossRefGoogle Scholar
Chen, C.L., Lai, P.H., Chou, K.J., Lee, P.T., Chung, H.M., Fang, H.C.A. (2007). Preliminary report of brain edema in patients with uremia at first hemodialysis: Evaluation by diffusion-weighted MR Imaging. AJNR American Journal of Neuroradiology, 28, 6871.Google ScholarPubMed
Coresh, J., Astor, B.C., Greene, T., Eknoyan, G., Levey, A.S. (2003). Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. American Journal of Kidney Diseases, 41, 112.CrossRefGoogle ScholarPubMed
Cukierman, T., Gerstein, H.C., Williamson, J.D. (2005). Cognitive decline and dementia in diabetes--systematic overview of prospective observational studies. Diabetologia, 48, 24602469.CrossRefGoogle ScholarPubMed
Cusumano, A.M., Di Gioia, C., Hermida, O., Lavorato, C.; Latin American Registry of Dialysis and Renal Transplantation. (2005). The Latin American Dialysis and Renal Transplantation Registry Annual Report 2002. Kidney International Supplement, 97, S46S52.CrossRefGoogle Scholar
Delanty, N., Vaughan, C., Frucht, S., Stubgen, P. (1997). Erythropoietin-associated hypertensive posterior leukoencephalopathy. Neurology, 49, 686689.CrossRefGoogle ScholarPubMed
Denny, S.D., Kuchibhatla, M.N., Cohen, H.J. (2006). Impact of anemia on mortality, cognition, and function in community-dwelling elderly. American Journal of Medicine, 119, 327334.CrossRefGoogle ScholarPubMed
Elias, M.F., Elias, P.K., Seliger, S.L., Narsipur, S.S., Dore, G.A., Robbins, M.A. (2009). Chronic kidney disease, creatinine and cognitive functioning. Nephrology Dialysis Transplantation, 24, 24462452.CrossRefGoogle ScholarPubMed
Gilli, P., De Bastiani, P. (1983). Cognitive function and regular dialysis treatment. Clinical Nephrology, 19, 188192.Google ScholarPubMed
Griva, K., Newman, S.P., Harrison, M.J., Hankins, M., Davenport, A., Hansraj, S., Thompson, D. (2003). Acute neuropsychological changes in hemodialysis and peritoneal dialysis patients. Health Psychology, 22, 570578.CrossRefGoogle ScholarPubMed
Hailpern, S.M., Melamed, M.L., Cohen, H.W., Hostetter, T.H. (2007). Moderate chronic kidney disease and cognitive function in adults 20 to 59 years of age: Third national health and nutrition examination survey (NHANES III). Journal of the American Society of Nephrology, 18, 22052213.CrossRefGoogle ScholarPubMed
Ikram, M.A., Vernooij, M.W., Hofman, A., Niessen, W.J., Van der Lugt, A., Breteler, M.M. (2008). Kidney function is related to cerebral small vessel disease. Stroke, 39, 5561.CrossRefGoogle ScholarPubMed
Iseki, K., Kinjo, K., Kimura, Y., Osawa, A., Fukiyama, K. (1993). Evidence for high risk of cerebral hemorrhage in chronic dialysis patients. Kidney International, 44, 10861090.CrossRefGoogle ScholarPubMed
Jassal, S.V., Roscoe, J., LeBlanc, D., Devins, G.M., Rourke, S. (2008). Differential impairment of psychomotor efficiency and processing speed in patients with chronic kidney disease. International Urology and Nephrology, 40, 849854.CrossRefGoogle ScholarPubMed
Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14, 540545.CrossRefGoogle ScholarPubMed
Kobayashi, M., Hirawa, N., Yatsu, K., Kobayashi, Y., Yamamoto, Y., Saka, S., Umemura, S. (2009). Relationship between silent brain infarction and chronic kidney disease. Nephrology Dialysis Transplantation, 24, 201207.CrossRefGoogle ScholarPubMed
Kurella, M., Chertow, G.M., Fried, L.F., Cummings, S.R., Harris, T., Simonsick, E., Yaffe, K. (2005). Chronic kidney disease and cognitive impairment in the elderly: The health, aging, and body composition study. Journal of the American Society of Nephrology, 16, 21272133.CrossRefGoogle ScholarPubMed
Kurella, M., Chertow, G.M., Luan, J., Yaffe, K. (2004). Cognitive impairment in chronic kidney disease. Journal of the American Geriatrics Society, 52, 18631869.CrossRefGoogle ScholarPubMed
Kurella, M., Luan, J., Lash, J.P., Chertow, G.M. (2005). Self-assessed sleep quality in chronic kidney disease. International Urology and Nephrology, 37, 159165.CrossRefGoogle ScholarPubMed
Kurella-Tamura, M., Wadley, V., Yaffe, K., McClure, L., Howard, G., Go, R., McClellan, W. (2008). Kidney function and cognitive impairment in US adults: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. American Journal of Kidney Diseases, 52, 227234.CrossRefGoogle ScholarPubMed
Kutlay, S., Nergizoglu, G., Duman, N., Atli, T., Keven, K., Ertrük, S., Karaton, O. (2001). Recognition of neurocognitive dysfunction in chronic hemodialysis patients. Renal Failure, 23, 781787.CrossRefGoogle ScholarPubMed
Kutner, N.G., Zhang, R., Huang, Y., Bliwise, D.L. (2007). Association of sleep difficulty with kidney disease quality of life cognitive function score reported by patients who recently started dialysis. Clinical Journal of the American Society of Nephrology, 2, 284289.CrossRefGoogle ScholarPubMed
Kuwabara, Y., Sasaki, M., Hirakata, H., Koga, H., Nakagawa, M., Chen, T., Fujishima, M. (2002). Cerebral blood flow and vasodilatory capacity in anemia secondary to chronic renal failure. Kidney International, 61, 564569.CrossRefGoogle ScholarPubMed
Lass, P., Buscombe, J.R., Harber, M. (1999). Cognitive impairment in patients with renal failure is associated with multiple-infarct dementia. Clinical Nuclear Medicine, 24, 561565.CrossRefGoogle ScholarPubMed
Levey, A.S., Bosch, J.P., Lewis, J.B., Greene, T., Rogers, N., Roth, D.A. (1999). More accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of Internal Medicine, 130, 461470.CrossRefGoogle ScholarPubMed
López-Alvarenga, J.C., Vázquez-Velázquez, V., Arcila-Martínez, D., Sierra-Ovando, A.E., González-Barranco, J., Salín-Pascual, R.J. (2002). Exactitud y utilidad diagnóstica del Hospital Anxiety and Depression Scale (HAD) en una muestra de sujetos obesos mexicanos. Revista de Investigación Clínica, 54, 403409.Google Scholar
Lucca, U., Tettamanti, M., Mosconi, P., Apolone, G., Gandini, F., Nobili, A., Riva, E. (2008). Association of mild anemia with cognitive, functional, mood and quality of life outcomes in the elderly: The “Health and Anemia” study. PLoS ONE, 2, 1920.CrossRefGoogle Scholar
Madan, P., Kalra, O.P., Agarwal, S., Tandon, O.P. (2007). Cognitive impairment in chronic kidney disease. Nephrology Dialysis Transplantation, 22, 440444.CrossRefGoogle ScholarPubMed
Murray, A.M. (2009). The brain and the kidney connection: A model of accelerated vascular cognitive impairment. Neurology, 73, 916917.CrossRefGoogle Scholar
Murray, A.M., Tupper, D.E., Knopman, D.S., Gilbertson, D.T., Pederson, S.L., Li, S., Kane, R.L. (2006). Cognitive impairment in hemodialysis patients is common. Neurology, 67, 216223.CrossRefGoogle ScholarPubMed
Nakatani, T., Naganuma, T., Uchida, J., Masuda, C., Wada, S., Sugimura, T., Sugimura, K. (2003). Silent cerebral infarction in hemodialysis patients. American Journal of Nephrology, 23, 8690.CrossRefGoogle ScholarPubMed
National Kidney Foundation. (2002). K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. American Journal of Kidney Diseases, 39, S1S266.Google Scholar
Okada, J., Yoshikawa, K., Matsuo, H., Kanno, K., Oouchi, M. (1991). Reversible MRI and CT findings in uremic encephalopathy. Neuroradiology, 33, 14321920.CrossRefGoogle ScholarPubMed
Ostrosky-Solís, F., Gómez-Pérez, M.E., Matute, E., Rosselli, M., Ardila, A., Pineda, D. (2007). Neuropsi attention and memory: A neuropsychological test battery in Spanish with norms by age and educational level. Applied Neuropsychology, 14, 156170.CrossRefGoogle ScholarPubMed
Pickett, J.L., Theberge, D.C., Brown, W.S., Schweitzer, S.U., Nissenson, A.R. (1999). Normalizing hematocrit in dialysis patients improves brain function. American Journal of Kidney Diseases, 33, 11221130.CrossRefGoogle ScholarPubMed
Pliskin, N.H., Yurk, H.M., Ho, L.T., Umans, J.G. (1996). Neurocognitive function in chronic hemodialysis patients. Kidney International, 49, 14351440.CrossRefGoogle ScholarPubMed
Prohovnik, I., Post, J., Uribarri, J., Lee, H., Sandu, O., Langhoff, E. (2007). Cerebrovascular effects of hemodialysis in chronic kidney disease. Journal of Cerebral Blood Flow and Metabolism, 27, 18611869.CrossRefGoogle ScholarPubMed
Seliger, S.L., Siscovick, D.S., Stehman-Breen, C.O., Gillen, D.L., Fitzpatrick, A., Bleyer, A., Kuller, L.H. (2004). Moderate renal impairment and risk of dementia among older adults: The cardiovascular health cognition study. Journal of the American Society of Nephrology, 15, 19041911.CrossRefGoogle ScholarPubMed
Shenal, B.V., Harrison, D.W., Demaree, H.A. (2003). The neuropsychology of depression: A literature review and preliminary model. Neuropsychology Review, 13, 3342.CrossRefGoogle ScholarPubMed
SPSS Inc. (1999). SPSS base 10.0 for Windows user’s guide. Chicago IL: SPSS Inc.Google Scholar
Toyoda, K., Fujii, K., Fujimi, S., Kumai, Y., Tsuchimochi, H., Ibayashi, S., Iida, M. (2005). Stroke in patients on maintenance hemodialysis: A 22-year single-center study. American Journal of Kidney Diseases, 45, 10581066.CrossRefGoogle ScholarPubMed
Vanholder, R., De Smet, R., Glorieux, G., Argiles, A., Bourmeister, U., Brunet, P., European Uremic Toxin Work Group (EUTox). (2003). Review of uremic toxins: Classification, concentration, and interindividual variability. Kidney International, 63, 19341943.CrossRefGoogle ScholarPubMed
Williams, M.A., Sklar, A.H., Burright, R.G., Donovick, P.J. (2004). Temporal effects of dialysis on cognitive functioning in patients with ESRD. American Journal of Kidney Diseases, 43, 705711.CrossRefGoogle ScholarPubMed
Wolcott, D.L., Wellisch, D.K., Marsh, J.T., Schaeffer, J., Landsverk, J., Nissenson, A.R. (1988). Relationship of dialysis modality and other factors to cognitive function in chronic dialysis patients. American Journal of Kidney Diseases, 12, 275284.CrossRefGoogle ScholarPubMed
World Health Organization. (2008). Worldwide prevalence of anaemia 1993–2005. Geneva: World Health Organization. Retrieved 2010-03-23 from http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdfGoogle Scholar
Yaffe, K., Ackerson, L., Tamura, M.K., Le Blanc, P., Kusek, J.W., Sehgal, A.R., Chronic Renal Insufficiency Cohort Investigators. (2010). Chronic kidney disease and cognitive function in older adults: Findings from the chronic renal insufficiency cohort cognitive study. Journal of the American Geriatrics Society, 58, 338345. doi:10.1111/j.1532-5415.2009.02670.xCrossRefGoogle ScholarPubMed
Zigmond, A.S., Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361370.CrossRefGoogle ScholarPubMed