Cognitive impairment linked to worse outcomes in chronic kidney disease

For patients with chronic kidney disease (CKD), cognitive impairment (CI) is associated with worse outcomes, according to a study published in the May issue of Kidney International Reports.

Hélène Levassort, M.D., from the Assistance Publique—Hôpitaux de Paris, and colleagues examined the specific impact of CI on adverse outcomes in CKD in a cohort that included 3,033 patients with CKD stage 2 to 5 and five years of follow-up. The Mini-Mental State Examination (MMSE) was used to assess CI.

The analysis included 3,004 patients; at baseline, 64%, 23%, and 13% had MMSE scores >26, 24 to 26, and <24, respectively. The researchers found that 21.5% of patients initiated kidney replacement therapy (KRT) during the mean follow-up period of 3.87 years; 13.4% died and 15.3% experienced a major adverse cardiovascular event (MACE) before KRT or noncardiovascular death. Compared with those with MMSE >26, those with MMSE <24 had a higher risk for clinical adverse outcome in adjusted Cox models (hazard ratios, 1.42, 1.57, and 1.32 for KRT initiation, all-cause mortality, and MACE, respectively). In the group with MMSE of 24 to 26, CI was associated with all-cause mortality (hazard ratio, 1.45).

“Our present findings highlight the prognostic value of cognitive status in CKD and suggest that a systematic cognitive assessment would be of relevance in routine nephrology care,” the authors write.

CKD-REIN is supported by a public-private partnership, with funding from 10 listed pharmaceutical companies; two authors disclosed ties to the pharmaceutical industry.

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