Emma O'Lone1, Michael Connors2, Philip Masson3, Sunny Wu4, Patrick J Kelly4, David Gillespie5, Daniel Parker6, William Whiteley5, Giovanni F M Strippoli7, Suetonia C Palmer8, Jonathan C Craig9, Angela C Webster10. 1. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. Electronic address: eolo0909@uni.sydney.edu.au. 2. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia; ARC Centre of Excellence in Cognition and Its Disorders, Sydney, Australia; Department of Cognitive Science, Macquarie University, Sydney, Australia. 3. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University of Edinburgh, Edinburgh, United Kingdom. 4. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. 5. University of Edinburgh, Edinburgh, United Kingdom. 6. Desert AIDS Project, Palm Springs, CA. 7. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; University of Bari, Bari, Italy; Diaverum Academy, Lund, Sweden. 8. University of Otago Christchurch, New Zealand. 9. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. 10. Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead, Sydney, Australia.
Abstract
BACKGROUND: Cognitive impairment is associated with poorer quality of life, risk for hospitalization, and mortality. Cognitive impairment is common in people with end-stage kidney disease treated with hemodialysis, yet the severity and specific cognitive deficits are uncertain. STUDY DESIGN: Systematic review and meta-analysis. SETTING & POPULATION: Adults receiving hemodialysis compared with the general population, people with non-dialysis-dependent chronic kidney disease (NDD-CKD), people receiving peritoneal dialysis, or people with nondialyzed chronic kidney failure. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials, cohort or cross-sectional studies without language restriction. INDEX TESTS: Validated neuropsychological tests of cognition. OUTCOMES: Cognitive test scores, aggregated by cognitive domain: orientation and attention, perception, memory, language, construction and motor performance, concept formation and reasoning, and executive functions. RESULTS: 42 studies of 3,522 participants. Studies were of high or uncertain risk of bias, assessed by the Newcastle-Ottawa Scale. People treated with hemodialysis had worse cognition than the general population, particularly in attention (n=22; standardized mean difference [SMD], -0.93; 95% CI, -1.18 to -0.68). Hemodialysis patients performed better than nondialyzed patients with chronic kidney failure in attention (n=6; SMD, 0.70; 95% CI, 0.45 to 0.96) and memory (n=6; SMD, 0.36; 95% CI, 0.08 to 0.63), but had poorer memory than the general population (n=16; SMD, -0.41; 95% CI, -0.91 to 0.09) and people with NDD-CKD (n=5; SMD, -0.40; 95% CI, -0.60 to -0.21). There were insufficient data to show other differences among people receiving hemodialysis and those receiving peritoneal dialysis or with NDD-CKD. LIMITATIONS: Potentially biased studies, not wholly adjusted for education. High heterogeneity, mainly due to the large variety of tests used to assess cognition. CONCLUSIONS: People treated with hemodialysis have impaired cognitive function compared to the general population, particularly in the domains of orientation and attention and executive function. Cognitive deficits in specific domains should be further explored in this population and should be considered when approaching education and chronic disease management.
BACKGROUND:Cognitive impairment is associated with poorer quality of life, risk for hospitalization, and mortality. Cognitive impairment is common in people with end-stage kidney disease treated with hemodialysis, yet the severity and specific cognitive deficits are uncertain. STUDY DESIGN: Systematic review and meta-analysis. SETTING & POPULATION: Adults receiving hemodialysis compared with the general population, people with non-dialysis-dependent chronic kidney disease (NDD-CKD), people receiving peritoneal dialysis, or people with nondialyzed chronic kidney failure. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials, cohort or cross-sectional studies without language restriction. INDEX TESTS: Validated neuropsychological tests of cognition. OUTCOMES: Cognitive test scores, aggregated by cognitive domain: orientation and attention, perception, memory, language, construction and motor performance, concept formation and reasoning, and executive functions. RESULTS: 42 studies of 3,522 participants. Studies were of high or uncertain risk of bias, assessed by the Newcastle-Ottawa Scale. People treated with hemodialysis had worse cognition than the general population, particularly in attention (n=22; standardized mean difference [SMD], -0.93; 95% CI, -1.18 to -0.68). Hemodialysis patients performed better than nondialyzed patients with chronic kidney failure in attention (n=6; SMD, 0.70; 95% CI, 0.45 to 0.96) and memory (n=6; SMD, 0.36; 95% CI, 0.08 to 0.63), but had poorer memory than the general population (n=16; SMD, -0.41; 95% CI, -0.91 to 0.09) and people with NDD-CKD (n=5; SMD, -0.40; 95% CI, -0.60 to -0.21). There were insufficient data to show other differences among people receiving hemodialysis and those receiving peritoneal dialysis or with NDD-CKD. LIMITATIONS: Potentially biased studies, not wholly adjusted for education. High heterogeneity, mainly due to the large variety of tests used to assess cognition. CONCLUSIONS:People treated with hemodialysis have impaired cognitive function compared to the general population, particularly in the domains of orientation and attention and executive function. Cognitive deficits in specific domains should be further explored in this population and should be considered when approaching education and chronic disease management.
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