Dr Isuru Gamage1, Dr SCOTT WILSON1,2, DR ARUP DHAR3,4, Mr PETER TREGASKIS2
1Department of Nephrology, Alfred Health, Melbourne, Australia, 2Central Clinical School, Monash University, Melbourne, Australia, 3Department of Psychiatry, Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia, 4Department of Psychiatry, Monash Health , Melbourne, Australia
Frequency and Risk Factors for Cognitive Dysfunction in Peritoneal Dialysis Patients
Background: There is limited data on cognition in patients undergoing peritoneal dialysis (PD).
Aim: We assessed prevalence and associated risk factors of neurocognitive impairment (NCI) in PD patients.
Methods: A cross-sectional cohort study of 150 PD patients at a single centre between 2016 and 2020 who underwent neurocognitive screening at defined intervals by Addenbrooke’s Cognitive Examination – Revised (ACE-R) with incorporated Mini-Mental State Examination (MMSE). Paired-sample t-test was used to compare whole score and cognitive subdomains to the general population. Risk factors and patient related outcome measures (PROMs) were evaluated using linear regression adjusted for sex, age and modality. Sub-analysis was performed in patients with a Beck’s Depression Inventory (BDI) score < 10.
Results: Patients on peritoneal dialysis performed poorly in ACE-R screening compared to population norms, with strongest discrepancy in domains of memory, fluency and visuospatial reasoning. In patients reporting no depressive features (BDI>10), these domains remained impaired with performance in attention and language comparable to norms. The MMSE detected cognitive impairment in 2% of studied patients, significantly fewer than when the ACE-R was applied (32%). Age, gender and self-reported symptoms of depression were associated with lower neurocognitive screening performance (p < 0.05).
Conclusions: Patients on peritoneal dialysis have higher prevalence of NCI than the general population, primarily with impairments in memory, fluency, and visuospatial reasoning. Depression confers poorer performance in attention and language domains. The MMSE is ineffective in detecting subtle NCI in this population compared with ACE-R. Risk factors for NCI include age, gender, and self-reported symptoms of depression.
Biography:
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