[Cognitive failure in terminal kidney disease]

Renal failure occurs more frequently among the elderly and elderly patients comprise an increasing proportion of dialysis patients. The objective of this paper is to review the frequency of cognitive impairment among elderly people in dialysis, and discuss causes and consequences of cognitive impairment and dementia in patients with end-stage renal disease. Prevention and treatment of cognitive impairment are discussed.

The review is based on literature retrieved from a search of Medline and other web-sites, review papers and clinical experience.

Cognitive impairment occurs in 20-87% of patients in haemodialysis, and the frequency is significantly more increased than that for control groups. The etiology is multifactorial, including the primary renal disease, comorbidity, the effect of uraemia and treatment-related factors. Potentially reversible factors such as anaemia and treatment complications may contribute to cognitive impairment in these patients. Cognitive impairment has major clinical consequences for compliance, resource use and the prognosis for patients with renal failure, and is often not detected by the clinicians. The authors propose that cognitive assessment should be included in the routine evaluation of elderly patients with renal failure, with potential implications for the treatment and quality of treatment for these patients.