title: Prevalence of cognitive impairment in patients attending pre-dialysis clinic.
abstract: Approximately 20-30% of patients on renal replacement therapy (RRT) have cognitive impairment. Less is known about the prevalence of cognitive impairment in patients with advanced kidney disease awaiting the initiation of dialysis. Routine cognitive assessment was implemented in the pre-dialysis clinic, which enabled the Nephrologist and Pre-dialysis Nurse to identify those patients with impaired cognitive function and utilise this information to assess the suitability for self-care treatments, such as peritoneal dialysis, as well as to adapt information to meet their needs. Subsequently, a cross-sectional single-centre audit was undertaken to identify the prevalence of cognitive impairment in 132 consecutive new referrals to the pre-dialysis clinic using the Mini-mental State Examination (MMSE). Twenty percent (95% CI = 0.13, 0.27) were classified as cognitively impaired. Those with cognitive impairment were significantly older, and had lower eGFR and higher serum creatinine. It can be concluded that approximately 1 in 5 patients attending the pre-dialysis clinic has cognitive impairment, which may not be apparent on a routine clinical history. Cognitive function assessment is recommended for all, but particularly to the older patient, before advising on choice of dialysis modality or opting for conservative treatment.
authors.affiliation: Renal Outpatients Department, East Wing Basement, Royal London Hospital, Barts and The London NHS Trust, London, UK. rebekah.nulsen@bartsandthelondon.nhs.uk
authors.forename: Rebekah S
authors.initials: RS
authors.lastname: Nulsen
authors.forename: M Magdi
authors.initials: MM
authors.lastname: Yaqoob
authors.forename: Althea
authors.initials: A
authors.lastname: Mahon
authors.forename: Meagan
authors.initials: M
authors.lastname: Stoby-Fields
authors.forename: Mike
authors.initials: M
authors.lastname: Kelly
authors.forename: Mira
authors.initials: M
authors.lastname: Varagunam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008487:Medical History Taking; D008609:Mental Status Schedule; D008875:Middle Aged; D009730:Nursing Assessment; D010044:Outpatient Clinics, Hospital; D018579:Patient Selection; D015995:Prevalence; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014850:Waiting Lists
chemical_list: D003404:Creatinine