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Cognitive Impairment Predicts Adverse Outcomes in CKD.

Hélène Levassort1,2, Yousra Hassan2, Julie Boucquemont2

  • 1Geriatric Department, University Medical Department 1, Assistance Publique - Hôpitaux de Paris (AP-HP), Ambroise Paré Hospital, University Hospital Group Paris Saclay, Boulogne-Billancourt, France.

Kidney International Reports
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Summary

Cognitive impairment (CI) in chronic kidney disease (CKD) patients with low Mini-Mental State Examination (MMSE) scores (< 24) indicates a higher risk of mortality, kidney replacement therapy, and major adverse cardiovascular events (MACEs). Early CI detection can personalize CKD management.

Keywords:
chronic kidney diseasecognitive impairmentkidney replacement therapymajor adverse cardiovascular eventmortality

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Area of Science:

  • Nephrology
  • Neurology
  • Epidemiology

Background:

  • Cognitive impairment (CI) negatively impacts chronic disease self-management, affecting decision-making, care adherence, and mortality.
  • The specific influence of CI on adverse outcomes in chronic kidney disease (CKD) is not well understood.

Purpose of the Study:

  • To investigate the association between cognitive impairment and adverse clinical outcomes in patients with CKD.
  • To determine the prognostic value of cognitive function assessment in CKD management.

Main Methods:

  • The French CKD - Renal Epidemiology and Information Network (CKD-REIN) cohort included 3033 patients with CKD stages 2-5.
  • Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE).
  • Cox models analyzed risks for all-cause mortality, kidney replacement therapy (KRT) initiation, and major adverse cardiovascular (CV) events (MACEs).

Main Results:

  • In a cohort of 3004 CKD patients (mean eGFR: 34 ml/min/1.73 m²), 13% had MMSE scores < 24.
  • Patients with MMSE < 24 showed significantly higher risks of KRT initiation (HR: 1.42), all-cause mortality (HR: 1.57), and MACEs (HR: 1.32) compared to those with MMSE > 26.
  • Mild cognitive impairment (MMSE 24-26) was also linked to increased all-cause mortality (HR: 1.45).

Conclusions:

  • A baseline MMSE score < 24 is a significant predictor of adverse outcomes, including mortality, KRT initiation, and MACEs in CKD patients.
  • Cognitive impairment has prognostic value in CKD, suggesting that early detection can aid in personalized patient management.
  • Integrating cognitive function assessment may improve the management of kidney and cardiovascular complications in CKD.