Meera N. Harhay|Dawei Xie|Xiaoming Zhang|Chi-yuan Hsu|Eric Vittinghoff|Alan S. Go|Stephen M. Sozio|Jacob B. Blumenthal|Stephen L. Seliger|Jing Chen|Rajat Deo|Mirela Dobre|Sanjeev Akkina|Peter P. Reese|James P. Lash|Kristine Yaffe|Manjula Kurella Tamura|Lawrence J. Appel|Harold I. Feldman|Alan S. Go|Jiang He|John W. Kusek|Panduranga S. Rao|Mahboob Rahman
Cognitive Impairment in Non–Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
Drexel University|University of Pennsylvania|University of Pennsylvania|University of California, San Francisco|Kaiser Permanente|University of California, San Francisco|Kaiser Permanente|University of California, San Francisco|Welch Foundation|Johns Hopkins Medicine|Johns Hopkins University|University of Maryland, Baltimore|University of Maryland, Baltimore|Tulane University|University of Pennsylvania|University Hospitals of Cleveland|Case Western Reserve University|Loyola University Medical Center|University of Pennsylvania|University of Illinois at Chicago|University of California, San Francisco|San Francisco VA Medical Center|Geriatric Research Education and Clinical Center|Palo Alto University|Stanford University|Kaiser Permanente|University of California, San Francisco|Tulane University
backgroundadvanced chronic kidney disease associated elevated risk cognitive impairment however known whether cognitive impairment associated planning preparation endstage renal diseasestudy designretrospective observational studysetting participants630 adults participating cric chronic renal insufficiency cohort study cognitive assessments latestage ckd defined estimated glomerular filtration rate 20 mlmin173 m2 subsequently initiated maintenance dialysis therapypredictorpredialysis cognitive impairment defined score modified minimental state examination lower previously derived agebased threshold scores covariates included age raceethnicity educational attainment comorbid conditions health literacyoutcomesperitoneal dialysis pd first dialysis modality preemptive permanent access placement venous catheter avoidance dialysis therapy initiation preemptive waitlisting kidney transplantmeasurementsmultivariableadjusted logistic regressionresultspredialysis cognitive impairment present 117 19 participants pd first dialysis modality among 16 participants n 100 75 preemptive access placed n 473 45 avoided using venous catheter dialysis therapy initiation n 279 20 preemptively waitlisted n 126 predialysis cognitive impairment independently associated 78 lower odds pd first dialysis modality adjusted aor 022 95 ci 006074 p 002 42 lower odds venous catheter avoidance dialysis therapy initiation aor 058 95 ci 034098 p 004 predialysis cognitive impairment independently associated preemptive permanent access placement waitlistinglimitationspotential unmeasured confounders single measure cognitive functionconclusionspredialysis cognitive impairment associated lower likelihood pd first dialysis modality venous catheter avoidance dialysis therapy initiation future studies may consider addressing cognitive function testing strategies improve patient transitions dialysis therapy advanced chronic kidney disease associated elevated risk cognitive impairment however known whether cognitive impairment associated planning preparation endstage renal disease retrospective observational study 630 adults participating cric chronic renal insufficiency cohort study cognitive assessments latestage ckd defined estimated glomerular filtration rate 20 mlmin173 m2 subsequently initiated maintenance dialysis therapy predialysis cognitive impairment defined score modified minimental state examination lower previously derived agebased threshold scores covariates included age raceethnicity educational attainment comorbid conditions health literacy peritoneal dialysis pd first dialysis modality preemptive permanent access placement venous catheter avoidance dialysis therapy initiation preemptive waitlisting kidney transplant multivariableadjusted logistic regression predialysis cognitive impairment present 117 19 participants pd first dialysis modality among 16 participants n 100 75 preemptive access placed n 473 45 avoided using venous catheter dialysis therapy initiation n 279 20 preemptively waitlisted n 126 predialysis cognitive impairment independently associated 78 lower odds pd first dialysis modality adjusted aor 022 95 ci 006074 p 002 42 lower odds venous catheter avoidance dialysis therapy initiation aor 058 95 ci 034098 p 004 predialysis cognitive impairment independently associated preemptive permanent access placement waitlisting potential unmeasured confounders single measure cognitive function predialysis cognitive impairment associated lower likelihood pd first dialysis modality venous catheter avoidance dialysis therapy initiation future studies may consider addressing cognitive function testing strategies improve patient transitions dialysis therapy