Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making

Area of Science:

• Nephrology
• Neuroscience
• Gerontology

Background:

• Cognitive impairment is prevalent in renal patients, yet its progression and impact on decision-making remain poorly understood.
• Dialysis modality (hemodialysis vs. peritoneal dialysis) may influence cognitive trajectories in patients with advanced kidney disease.

Purpose of the Study:

• To evaluate and compare cognitive trends among chronic kidney disease (CKD), hemodialysis (HD), and peritoneal dialysis (PD) patients.
• To assess the relationship between cognitive impairment and decision-making capacity (DMC) in this patient population.

Main Methods:

• Prospective study involving 102 patients (36 CKD, 41 HD, 25 PD) recruited from outpatient clinics.
• Cognitive function assessed using the Montreal Cognitive Assessment (MoCA) tool every 4 months for up to 2 years.
• Decision-making capacity evaluated using the Macarthur Competency Assessment tool (MacCAT-T).

Main Results:

• Total MoCA scores declined significantly faster in dialysis patients compared to CKD patients (P=0.025).
• Executive MoCA scores declined faster in HD patients than in PD patients (P=0.037).
• Patients with cognitive impairment (MoCA < 26) demonstrated lower MacCAT-T scores, indicating impaired decision-making capacity (P=0.049).

Conclusions:

• Cognitive function deteriorates more rapidly in dialysis patients, particularly those on hemodialysis, compared to non-dialysis CKD patients.
• Cognitive impairment is associated with reduced decision-making capacity in patients with advanced kidney disease.