Cognitive Impairment in Chronic Kidney Disease

Authors

  • Manjula Kurella MD,

    1. From the Divisions of *NephrologyPsychiatry, Neurology, and §Epidemiology, Department of Medicine, University of California at San Francisco, Moffitt-Long Hospitals, UCSF-Mt. Zion Medical Center, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
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  • Glenn M. Chertow MD, MPH,

    1. From the Divisions of *NephrologyPsychiatry, Neurology, and §Epidemiology, Department of Medicine, University of California at San Francisco, Moffitt-Long Hospitals, UCSF-Mt. Zion Medical Center, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
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  • Jennifer Luan BA,

    1. From the Divisions of *NephrologyPsychiatry, Neurology, and §Epidemiology, Department of Medicine, University of California at San Francisco, Moffitt-Long Hospitals, UCSF-Mt. Zion Medical Center, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
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  • Kristine Yaffe MD

    1. From the Divisions of *NephrologyPsychiatry, Neurology, and §Epidemiology, Department of Medicine, University of California at San Francisco, Moffitt-Long Hospitals, UCSF-Mt. Zion Medical Center, and San Francisco Veterans Affairs Medical Center, San Francisco, California.
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  • Dr. Kurella was supported by the American Kidney Fund Clinical Scientist in Nephrology Award. Dr. Chertow was supported by Grants RO1 DK58411 and RO1 DK01005 from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Yaffe was supported by Grants AG00888 and R01 AG021918 from the National Institutes of Health, National Institute on Aging, and the Paul Beeson Scholars in Aging Program. An abstract describing these findings was presented at the 2003 American Society of Nephrology Meeting.

Kristine Yaffe, MD, University of California San Francisco, Box 181, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94143. E-mail: kyaffe@itsa.ucsf.edu

Abstract

Objectives: To assess the prevalence of cognitive impairment in persons with chronic kidney disease (CKD) and its relation to the severity of CKD.

Design: Cross-sectional study.

Setting: University-affiliated ambulatory nephrology and dialysis practices.

Participants: Eighty subjects with CKD Stages III and IV not requiring dialysis (CKD) and 80 subjects with CKD Stage V on hemodialysis (end-stage renal disease (ESRD)) with a mean age±standard deviation of 62.5±14.3.

Measurements: Three standardized cognitive tests, the Modified Mini-Mental State Examination (3MS), Trailmaking Test B (Trails B), and California Verbal Learning Trial (CVLT). Glomerular filtration rate was estimated in subjects with CKD using the six-variable Modification of Diet in Renal Disease equation.

Results: There was a graded relation between cognitive function and severity of CKD. Mean scores on the 3MS, Trails B, and CVLT immediate and delayed recall were significantly worse for subjects with ESRD than for subjects with CKD or published norms (P<.001 for all comparisons). Scores on the Trails B (P<.001) and CVLT immediate (P=.01) and delayed (P<.001) recall were significantly worse for subjects with CKD not requiring dialysis than for published norms. In addition, the fraction of subjects with impairment on the 3MS and Trails B increased with decreasing kidney function.

Conclusion: Cognitive impairment is associated with the severity of kidney disease. Further studies are needed to determine the reasons for cognitive impairment in subjects with CKD and ESRD.

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