Quantifying cognitive dysfunction across the spectrum of end-stage kidney disease: A systematic review and meta-analysis.

Publisher: Blackwell Science Country of Publication: Australia NLM ID: 9615568 Publication Model: Print Cited Medium: Internet ISSN: 1440-1797 (Electronic) Linking ISSN: 13205358 NLM ISO Abbreviation: Nephrology (Carlton) Subsets: MEDLINE

Original Publication: Carlton, Vic., Australia : Blackwell Science,

Cognition* ; Neuropsychological Tests*; Cognition Disorders/*diagnosis ; Kidney Failure, Chronic/*diagnosis; Cognition Disorders/epidemiology ; Cognition Disorders/psychology ; Humans ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/psychology ; Kidney Failure, Chronic/therapy ; Kidney Transplantation ; Mental Status and Dementia Tests ; Peritoneal Dialysis ; Predictive Value of Tests ; Prevalence ; Prognosis ; Renal Dialysis ; Risk Factors ; Trail Making Test ; Wechsler Scales

Cognitive dysfunction is reportedly highly prevalent among chronic kidney disease (CKD) patients. A variety of screening tools and neuropsychiatric batteries are used to quantify the magnitude and nature of this dysfunction. Our objective is to summarize the neurocognitive testing used, and determine what degree cognitive dysfunction is reported in CKD patients. All study designs published in English that contained participants who were either pre-dialysis patients, haemodialysis (HD) or peritoneal dialysis (PD) patients or renal transplant recipients were considered. Reported comparative non-CKD control data was also collected. All study designs were included. The search period encompassed articles from 1980 to May 2018. This review is registered with PROSPERO (CRD42018096568). Of the 1711 articles screened, 148 articles were relevant and used in the meta-analysis. Commonly used assessments were The Mini-Mental State Examination (MMSE), The Modified Mini-Mental State Examination, the Trails Making Tests (TMT) forms A and B and components of the Wechsler Adult Intelligence Scale: Digit Span and Digit Symbol. Means for all assessments were adjusted using a random effects model to account for the differences in variance. Adjusted mean MMSE scores were significantly lower for both pre-dialysis (26.08, n = 17 073) and HD (26.31, n = 3314) patients when compared to non-CKD controls (28.21, n = 5226). PD (58.01 s, n = 859) and HD (56.04 s, n = 2344) patients also took significantly longer to complete the Trails Making Task A than non-CKD controls (37.62 s, n = 4809). Patients with CKD, especially pre-dialysis and those requiring dialysis, are likely to exhibit impairments in cognition that can be identified with specific screening neuropsychological assessments.
(© 2018 Asian Pacific Society of Nephrology.)

Keywords: Trails Making Test; cognitive dysfunction; end-stage kidney disease; haemodialysis; meta-analysis; the Mini-Mental State Examination

Date Created: 20180811 Date Completed: 20190409 Latest Revision: 20190409

20240104

10.1111/nep.13448

30094890