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Cognitive Dysfunction Screening in Peritoneal Dialysis Patients: A Cross-Sectional Study
Ana C Brás1, Joana Marques2, Vasco Fernandes2
1Department of Nephrology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
Background:
Mild cognitive impairment (MCI) in peritoneal dialysis (PD) patients has been described as a risk factor for worse outcomes such as peritonitis, technique failure, and mortality. In this study, we aimed to determine the prevalence of MCI in a population of PD patients and identify the possible risk factors associated with MCI.
Materials And Methods:
We performed an observational, cross-sectional study to evaluate cognitive function using the Montreal Cognitive Assessment (MOCA) test and the Mini Mental State Examination (MMSE) test in PD patients. Patients with diagnosis of dementia or severe neurologic impairment, active cancer, or infection were excluded.
Results:
We evaluated 66 patients (mean age 60 years); 53% were male. Prevalence of MCI assessed by MOCA test and MMSE test was 65% and 33%, respectively. Predictors of MCI with MOCA test were higher age (P = 0.0001), lower education level (P = 0.005), need of a helper (P = 0.009), and continuous ambulatory PD modality (P = 0.019). Higher Charlson comorbidity index (P = 0.002), coronary artery disease (P = 0.006), and peripheral artery disease (P = 0.033) were also associated with MCI. Lower Kt/V (P = 0.012) and lower levels of normalized protein catabolic rate (nPCR; P < 0.000) were related to MCI. MCI patients had more episodes of peritonitis (P = 0.047). Multivariable analysis showed that lower education, Kt/V, and nPCR were the most relevant factors connected to MCI (P = 0.029, P = 0.037, and P = 0.019, respectively).
Conclusion:
In our PD population, MCI was detected in more than half of the patients. Patients with MCI were older, had lower education level, more disease burden, and higher risk for developing peritonitis. Lower Kt/V and nPCR levels were associated with MCI.
Insights
Mild cognitive impairment (MCI) affects over half of peritoneal dialysis (PD) patients, linked to poorer health outcomes. Key risk factors include advanced age, low education, and reduced dialysis efficiency (Kt/V, nPCR).
Area of Science:
- Nephrology
- Neurology
- Geriatrics
Background:
- Mild cognitive impairment (MCI) is a known risk factor for adverse outcomes in peritoneal dialysis (PD) patients, including peritonitis, technique failure, and mortality.
- Understanding the prevalence and risk factors of MCI in PD patients is crucial for improving patient management and outcomes.
Purpose of the Study:
- To determine the prevalence of MCI in a PD patient population.
- To identify potential risk factors associated with MCI in PD patients.
Main Methods:
- An observational, cross-sectional study was conducted.
- Cognitive function was assessed using the Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) tests.
- Exclusion criteria included dementia, severe neurologic impairment, active cancer, or infection.
Main Results:
- MCI prevalence was 65% (MOCA) and 33% (MMSE) in 66 PD patients (mean age 60, 53% male).
- Predictors of MCI included higher age, lower education, need for a helper, and continuous ambulatory PD modality.
- Higher comorbidity index, coronary artery disease, peripheral artery disease, lower Kt/V, and lower normalized protein catabolic rate (nPCR) were associated with MCI.
- MCI patients experienced more peritonitis episodes.
Conclusions:
- MCI is highly prevalent in PD patients, affecting over half the cohort.
- MCI is associated with older age, lower education, increased disease burden, and a higher risk of peritonitis.
- Lower dialysis adequacy (Kt/V) and reduced protein catabolism (nPCR) are significant factors linked to MCI in PD patients.
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