Cognitive Impairment Predicts Adverse Outcomes in CKD

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.