Cognitive Changes in Peritoneal Dialysis Patients: A Multicenter Prospective Cohort Study

Area of Science:

• Nephrology
• Neuropsychology
• Gerontology

Background:

• Cognitive impairment is a significant predictor of mortality and technique failure in patients undergoing peritoneal dialysis (PD).
• Understanding cognitive changes and associated factors in PD patients is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate changes in global and specific cognitive functions over two years in patients on PD therapy.
• To identify factors, including hypoalbuminemia and depression, associated with cognitive decline in this population.

Main Methods:

• A multicenter prospective cohort study involving 458 PD patients followed for two years.
• Cognitive function assessed using the Modified Mini-Mental State Examination (3MS) and Trail-Making Tests; memory, visuospatial skills, and language evaluated using the Battery for the Assessment of Neuropsychological Status.
• Multivariable linear regression models analyzed changes in cognitive function and associations with clinical factors.

Main Results:

• The prevalence of cognitive impairment increased from 19.8% to 23.9% over two years.
• Global cognitive function (3MS scores) declined, while executive function, immediate memory, and visuospatial skills showed improvement.
• Lower serum albumin, advanced age, lower education, and depression were significantly associated with cognitive deterioration and increased hospitalization rates.

Conclusions:

• Global cognitive function declines in PD patients over two years, despite improvements in some specific domains.
• Hypoalbuminemia and depression are identified as significant risk factors for cognitive impairment in PD patients, alongside age and education.
• Cognitive impairment is linked to higher hospitalization rates and reduced survival in PD patients, highlighting the need for targeted interventions.