The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice
Kidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association...
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doaj-d6f644366ef74154b41a9a8603f422d72020-11-24T22:32:26ZengElsevierKidney International Reports2468-02492016-11-011424024910.1016/j.ekir.2016.07.010The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality ChoiceA. Jayanti0P. Foden1P. Brenchley2A. Wearden3S. Mitra4Renal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UKDepartment of Biostatistics, University of Manchester, Manchester, UKRenal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UKSchool of Psychological Sciences, University of Manchester, Manchester, UKRenal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UKKidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association with self-care dialysis modality choice. Methods: Cross-sectional data from the Barriers to Successful Implementation of Care in Home Haemodialysis study were used for the study of cognition in 220 predialysis patients. The data were used to ascertain the demographics, clinical, laboratory, and neuropsychometric variables. The latter includes Trail Making Tests (TMT) parts A and B, Modified Mini Mental State Examination, and metacognition questionnaire for subjective assessment of one’s cognitive ability. The outcome variable was fully assisted and self-care dialysis modality choice. Results: Within the study cohort, 90 patients chose fully assisted hemodialysis and 114 patients chose self-care dialysis. The median Modified Mini Mental State Examination, TMT part A, and TMT part B scores were greater for the assisted versus the self-care group. Metamemory was not significantly different between groups, but the metaconcentration score was significantly worse in the group choosing assisted dialysis. Higher (i.e., better) metaconcentration scores were significantly associated with the self-care modality choice in the univariate and hierarchical regression analyses. Adjusted and unadjusted analyses showed a significant association between perceived concentration and TMT part B scores (P < 0.01). With every 1.6-minute increase in TMT part B score, there was a 1-unit reduction in metaconcentration score, and the latter was associated with 20% lower odds of choosing self-care dialysis over a fully assisted dialysis modality. Discussion: Patients’ self-perception of cognitive ability is a significant predictor of self-care dialysis modality choice. Subjective report of “metaconcentration” is also strongly associated with poorer outcome on the TMT part B.http://www.sciencedirect.com/science/article/pii/S2468024916300559cognitionESRDpredialysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
A. Jayanti P. Foden P. Brenchley A. Wearden S. Mitra |
spellingShingle |
A. Jayanti P. Foden P. Brenchley A. Wearden S. Mitra The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice Kidney International Reports cognition ESRD predialysis |
author_facet |
A. Jayanti P. Foden P. Brenchley A. Wearden S. Mitra |
author_sort |
A. Jayanti |
title |
The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice |
title_short |
The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice |
title_full |
The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice |
title_fullStr |
The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice |
title_full_unstemmed |
The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice |
title_sort |
burden of cognitive impairment in patients with end-stage renal disease and impact on dialysis modality choice |
publisher |
Elsevier |
series |
Kidney International Reports |
issn |
2468-0249 |
publishDate |
2016-11-01 |
description |
Kidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association with self-care dialysis modality choice.
Methods: Cross-sectional data from the Barriers to Successful Implementation of Care in Home Haemodialysis study were used for the study of cognition in 220 predialysis patients. The data were used to ascertain the demographics, clinical, laboratory, and neuropsychometric variables. The latter includes Trail Making Tests (TMT) parts A and B, Modified Mini Mental State Examination, and metacognition questionnaire for subjective assessment of one’s cognitive ability. The outcome variable was fully assisted and self-care dialysis modality choice.
Results: Within the study cohort, 90 patients chose fully assisted hemodialysis and 114 patients chose self-care dialysis. The median Modified Mini Mental State Examination, TMT part A, and TMT part B scores were greater for the assisted versus the self-care group. Metamemory was not significantly different between groups, but the metaconcentration score was significantly worse in the group choosing assisted dialysis. Higher (i.e., better) metaconcentration scores were significantly associated with the self-care modality choice in the univariate and hierarchical regression analyses. Adjusted and unadjusted analyses showed a significant association between perceived concentration and TMT part B scores (P < 0.01). With every 1.6-minute increase in TMT part B score, there was a 1-unit reduction in metaconcentration score, and the latter was associated with 20% lower odds of choosing self-care dialysis over a fully assisted dialysis modality.
Discussion: Patients’ self-perception of cognitive ability is a significant predictor of self-care dialysis modality choice. Subjective report of “metaconcentration” is also strongly associated with poorer outcome on the TMT part B. |
topic |
cognition ESRD predialysis |
url |
http://www.sciencedirect.com/science/article/pii/S2468024916300559 |
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