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

2020 ◽  
Vol 9 (7) ◽  
pp. 2202
Author(s):  
Mirko Di Rosa ◽  
Sonia D’Alia ◽  
Francesco Guarasci ◽  
Luca Soraci ◽  
Elisa Pierpaoli ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Kidney Disease ◽  
Older Patients ◽  
Cox Regression ◽  
Acute Care Hospital ◽  
Potential Interaction ◽  
Care Hospital ◽  
Increased Risk ◽  
Constructional Apraxia

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.

scholarly journals Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000672
Author(s):  
Ryan Pratt ◽  
Mete Erdogan ◽  
Robert Green ◽  
David Clark ◽  
Amanda Vinson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Nova Scotia ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Major Trauma ◽  
Injury Severity ◽  
Cox Regression ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

Abstract P255: Association of Mild Chronic Kidney Disease with Venous Thromboembolism: Pooled Analysis of Prospective General Population Cohorts

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Bakhtawar K Mahmoodi ◽  
Ron T Gansevoort ◽  
Inger Anne Naess ◽  
Pamela L Lutsey ◽  
Sigrid K Braekkan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Venous Thromboembolism ◽  
Kidney Disease ◽  
General Population ◽  
Cox Regression ◽  
Meta Analysis ◽  
Random Effect ◽  
Pooled Analysis ◽  
Individual Level ◽  
Increased Risk

Background: Recent findings suggest that mild chronic kidney disease (CKD) might be associated with increased risk of venous thromboembolism (VTE). However, results were partially inconsistent, which may be due to lack of power. We therefore performed a meta-analysis to investigate the association between mild CKD and VTE incidence. Methods: A literature search was performed to retrieve community-based cohorts with information on the association of estimated glomerular filtration rate (eGFR) and albuminuria with VTE. Five cohorts were identified that were pooled on individual level. To obtain pooled hazard ratios (HRs) for VTE, linear spline models were fitted using Cox regression with shared-frailty. Models were adjusted for age, sex, hypertension, total cholesterol, smoking, diabetes, history of cardiovascular disease and body-mass index. Random-effect meta-analysis was used to obtain adjusted pooled HRs of VTE with CKD versus no CKD. Results: The analysis included 95,154 participants with 1,178 VTE cases and 599,453 person-years of follow-up. Risk of VTE increased continuously with lower eGFR and higher ACR (Figure). Compared with eGFR 100 mL/min/1.73m², pooled adjusted HRs for VTE were 1.3 (1.0–1.7) for eGFR 60, 1.8 (1.3–2.6) for 45 and 1.9 (1.2–2.9) for 30 mL/min/1.73m². Compared with albumin-creatinine ratio (ACR) 5 mg/g, pooled adjusted HRs for VTE were 1.3 (1.04–1.7) for ACR 30, 1.6 (1.1–2.4) for 300 and 1.9 (1.2–3.1) for 1000 mg/g. There was no evidence for interaction between eGFR and ACR (P=0.22). The pooled adjusted HR for CKD (eGFR <60 ml/min/1.73m² or albuminuria ≥30 mg/g) vs. no CKD was 1.5 (95%CI, 1.2–2.1). Results were similar for idiopathic and provoked VTE. Conclusion: Both reduced eGFR and elevated albuminuria are novel independent predictors of VTE in the general population.

scholarly journals Communication behavior of cognitively impaired older inpatients

2019 ◽  
Vol 52 (S4) ◽  
pp. 264-272
Author(s):  
Eva-Luisa Schnabel ◽  
Hans-Werner Wahl ◽  
Susanne Penger ◽  
Julia Haberstroh
Keyword(s):  
Cognitive Impairment ◽  
Psychometric Properties ◽  
Acute Care ◽  
Older Patients ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Well Being ◽  
Communication Behavior ◽  
Care Hospital

Abstract Background and objective Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients’ well-being, healthcare decisions, and medical outcomes. As validated measures are lacking, we tested the psychometric properties of an observational instrument to assess Communication Behavior in Dementia (CODEM) in the acute care hospital setting. As a novel feature, we were also able to incorporate linguistic and social-contextual measures. Material and methods Data were drawn from a cross-sectional mixed methods study that focused on the occurrence of elderspeak during care interactions in two German acute care hospitals. A total of 43 acutely ill older patients with severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were observed by trained research assistants during a standardized interview situation and rated afterwards by use of CODEM. Results Factor analysis supported the expected two-factor solution for the CI group, i.e., a verbal content and a nonverbal relationship aspect. Findings of the current study indicated sound psychometric properties of the CODEM instrument including internal consistency, convergent, divergent, and criterion validity. Conclusion CODEM represents a reliable and valid tool to examine the communication behavior of older patients with CI in the acute care hospital setting. Thus, CODEM might serve as an important instrument for researcher and healthcare professionals to describe and improve communication patterns in this environment.

Association between Extreme Values of Markers of Chronic Kidney Disease: Mineral and Bone Disorder and 5-Year Mortality among Prevalent Hemodialysis Patients

2017 ◽  
Vol 45 (1-3) ◽  
pp. 1-7 ◽  
Author(s):  
Jin-Gang Zhu ◽  
Jin-Bor Chen ◽  
Ben-Chung Cheng ◽  
Chih-Hsiung Lee ◽  
Gang Long ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Regression Models ◽  
Cox Regression ◽  
Extreme Values ◽  
Journal Club ◽  
Mineral And Bone Disorder ◽  
Increased Risk ◽  
Bone Disorder ◽  
All Cause Mortality

Background/Aims: We examined the association between markers of chronic kidney disease - mineral and bone disorder (CKD-MBD) and mortality in hemodialysis (HD) patients. Methods: We retrospectively reviewed the association between markers of CKD-MBD and mortality in 1,126 HD patients from 2009 to 2013 with baseline (B), time-average (TA), and time-dependent (TD) Cox regression models. Results: Hypercalcemia (10.9-11.9 mg/dL) indicated an increased risk of all-cause mortality (TA: hazard ratio [HR] 3.49; p = 0.01). Hypophosphatemia (2.0-2.5 mg/dL) was significantly associated with an increased risk of all-cause mortality (TA: HR 5.18; p = 0.01). Hypophosphatemia (<2.0 mg/dL) was significantly associated with an increased risk of cardiovascular mortality in all models. Intact parathyroid hormone levels <60 and >1,500 pg/mL indicated an increased risk of all-cause mortality (TA: HR 1.64; p = 0.02; TD: HR 2.26; p = 0.02). Conclusion: Extreme values of CKD-MBD markers are associated with mortality risk in HD patients. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=478972.

scholarly journals Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Ulf G. Bronas ◽  
Houry Puzantian ◽  
Mary Hannan
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Kidney Disease ◽  
Physical Function ◽  
Vascular Dysfunction ◽  
Therapeutic Modality ◽  
Increased Risk

Chronic kidney disease (CKD) is considered a model of accelerated aging. More specifically, CKD leads to reduced physical functioning and increased frailty, increased vascular dysfunction, vascular calcification and arterial stiffness, high levels of systemic inflammation, and oxidative stress, as well as increased cognitive impairment. Increasing evidence suggests that the cognitive impairment associated with CKD may be related to cerebral small vessel disease and overall impairment in white matter integrity. The triad of poor physical function, vascular dysfunction, and cognitive impairment places patients living with CKD at an increased risk for loss of independence, poor health-related quality of life, morbidity, and mortality. The purpose of this review is to discuss the available evidence of cerebrovascular-renal axis and its interconnection with early and accelerated cognitive impairment in patients with CKD and the plausible role of exercise as a therapeutic modality. Understanding the cerebrovascular-renal axis pathophysiological link and its interconnection with physical function is important for clinicians in order to minimize the risk of loss of independence and improve quality of life in patients with CKD.

scholarly journals Correlation Between Cognitive Function Impairment and Chronic Kidney Disease With a Low Glomerular Filtration Rate at Sanglah Hospital Denpasar

2020 ◽  
Vol 8 (B) ◽  
pp. 752-756
Author(s):  
Anak Agung Ayu Putri Laksmidewi ◽  
Cok Istri Gangga Dewi Dewi ◽  
Yennny Kandarini
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Control Group ◽  
Case Group ◽  
Increased Risk

BACKGROUND: Chronic kidney disease is a condition of chronic kidney damage with abnormal structure and function of the kidneys that lasts more than 3 months, accompanied or not by a decrease in glomerular filtration rate. Organic kidney disease leaves accumulated organic waste that cannot be removed by the kidneys. Furthermore, several biochemical and metabolic mechanisms such as chronic inflammation and oxidative stress can cause executive disorders. AIM: The aim of the study was to find out an increased risk of impaired cognitive function in patients with chronic kidney disease with a low glomerular filtration rate in Sanglah Hospital. METHOD: This study uses a retrospective case–control analytic observational study design. We included all patients with chronic kidney disease in Sanglah Hospital in December 2017–January 2018. This study involved 46 subjects with chronic kidney disease who met eligibility criteria, classified as a case group with cognitive impairment and a control group without cognitive impairment. RESULTS: Each decrease in glomerular filtration rate < 30 ml/min/173 m2 in patients with chronic renal failure correlates with an increased incidence of cognitive impairment of around 15–25%. The risk of chronic kidney disease patients with glomerular filtration rate < 30 ml/min/1.73 m2 decreased cognitive function 13 times compared to subjects with glomerular filtration rate > 30 ml/min/ 1.73 m2. CONCLUSION: Low glomerular filtration rate correlate with increased risk of cognitive impairment.

scholarly journals Association between serum phosphorus levels and adverse outcomes in chronic kidney disease: an observational cohort study

2021 ◽  
Author(s):  
Akira Oda ◽  
Kenichi Tanaka ◽  
Hirotaka Saito ◽  
Tsuyoshi Iwasaki ◽  
Shuhei Watanabe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Serum Phosphorus ◽  
Increased Risk ◽  
Phosphorus Levels

Abstract Background Although an association between serum phosphorus levels and poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum phosphorus levels and adverse outcomes such as kidney events, cardiovascular events, and all-cause death in Japanese NDD-CKD patients, using the longitudinal data of the Fukushima CKD Cohort Study. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum phosphorus with kidney events, cardiovascular events, and all-cause death. Results Over a median follow-up period of 2.8 years, 46 patients died, there were 50 cardiovascular events, and 102 kidney events occurred. Increased risk of kidney events was observed in patients with higher serum phosphorus, with the lowest risk shown to be a second quartile of serum phosphorus level of 2.9–3.2 mg/dL. Multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum phosphorus levels (≥ 3.7 mg/dL) versus the second quartile (2.9–3.2 mg/dL, hazard ratio, 3.62; 95% confidence interval, 1.65–7.94; P = 0.001). A 1 mg/dL increase of the serum phosphorus was associated with an adjusted hazard ratio of 1.66 (95% CI; 1.24–2.20) for the kidney events. There were no significant associations between the serum phosphorus levels at baseline and the risk of cardiovascular events and all-cause death. Conclusions Serum phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.

scholarly journals Nitride oxide synthase 3 and klotho gene polymorphisms in the pathogenesis of chronic kidney disease and age-related cognitive impairment: a systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 252
Author(s):  
Atma Gunawan ◽  
Jonny Karunia Fajar ◽  
Fredo Tamara ◽  
Aditya Indra Mahendra ◽  
Muhammad Ilmawan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Initial Assessment ◽  
Age Related ◽  
Increased Risk ◽  
Nitride Oxide ◽  
Oxide Synthase ◽  
Increased Susceptibility

Background: While it has been known that the development of chronic kidney disease (CKD) and age-related cognitive impairment involves several mediators, the evidence in clinical practice only reveals nitride oxide synthase (NOS) and klotho. However, the evidence for this topic is conflicted. The aim of this study was to assess the role of NOS and klotho single nucleotide polymorphisms (SNPs) in the pathogenesis of CKD and age-related cognitive impairment. Methods: We performed a meta-analysis during October to December 2019. Paper collection was performed in major scientific websites, and we extracted information of interest from each paper. Data were analyzed using a Z-test with either random or fixed effect model. Results: Our initial assessment identified NOS3 G894T, NOS3 T786C, NOS3 4b/4a, klotho (KL) G395A, and KL C1818T as the gene candidate for our meta-analysis. Our pooled calculation revealed that NOS3 G894T was associated with the risk of both age-related cognitive impairment and CKD. Increased susceptibility to age-related cognitive impairment was observed in the GG genotype, and increased risk of CKD was found in patients with a single T allele and TT genotype for NOS3 nucleotide 894. For NOS3 4b/4a, increased risk of CKD was only found in 4a4a genotype. For NOS3 T786C, we failed to show the association with both CKD and age-related cognitive impairment. Subsequently, for KL G395A, A allele and GA genotype were found to correlate with increased susceptibility to CKD, while its correlation to age-related cognitive impairment was failed to clarify. For KL C1818T, our analysis failed to find the correlation with the risk of CKD. Conclusions: Our results reveal that the NOS3 G894T gene polymorphism has a crucial role in the pathogenesis of both CKD and age-related cognitive impairment.

scholarly journals Cognitive impairment in patients with moderate to severe chronic kidney disease: the Salford kidney cohort study

2020 ◽  
Author(s):  
James Tollitt ◽  
Aghogho Odudu ◽  
Daniela Montaldi ◽  
Philip A Kalra
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Kidney Disease ◽  
Vascular Disease ◽  
Older Age ◽  
Cognitive Assessments ◽  
Previous Stroke ◽  
Increased Risk ◽  
Severe Chronic Kidney Disease

Abstract Background Cognitive impairment in chronic kidney disease (CKD) is common and underrecognized [1, 2]. Determining risk factors for cognitive impairment and whether speed of CKD progression is an important consideration may help identify cognitive impairment by nephrologists. Vascular disease is thought to underpin cognitive impairment in CKD and by segregating CKD patients with proven vascular disease, we may also be able to discover other important associations with cognitive impairment in CKD patients. Method A total of 250 patients in a UK prospective cohort of CKD patients underwent two cognitive assessments: Montreal Cognitive Assessment test and Trail Making Test. Cognitive impairment was defined using validated population cut-offs (cognitive impairment) and relative cognitive impairment. Relative cognitive impairment was defined by &lt;1 standard deviation below the mean Z-score on any completed test. Two multivariable logistical regression models identified variables associated with cognitive impairment and realtive cognitive impairment. Results About 44 and 24.8% of patients suffered cognitive impairment and relative cognitive impairment, respectively. Depression, previous stroke and older age were significantly associated with cognitive impairment. Older age was significantly associated with relative cognitive impairment (P ≤ 0.05) and higher proteinuria and the use of psychodynamic medications were also significantly associated with relative cognitive impairment (P = 0.05). Delta estimated glomerular filtration rate (eGFR) in patients with cognitive impairment and relative cognitive impairment compared with those having normal cognition was similar (−0.77 versus −1.35 mL/min/1.73 m2/year, P = 0.34 for cognitive impairment and −1.12 versus −1.02 mL/min/1.73 m2/year, P = 0.89 for relative cognitive impairment). Conclusion Risk factors for cognitive impairment in CKD include previous stroke, depression or anxiety, higher proteinuria and prescription of psychodynamic medications. Patients with a faster eGFR decline do not represent a group of patients at increased risk of cognitive impairment.

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