title: Cognitive impairment in peritoneal dialysis patients.
abstract: BACKGROUND
  The prevalence of moderate to severe cognitive impairment in hemodialysis patients is more than double the prevalence in the general population. This study describes cognitive impairment occurrence in a peritoneal dialysis cohort compared with a cohort without chronic kidney disease (CKD).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  51 English-speaking peritoneal dialysis patients from 2 urban dialysis units compared with 338 hemodialysis patients from 16 urban dialysis units and 101 voluntary controls without CKD from urban general medicine clinics.
  
  
  METHODS
  45-minute battery of 9 validated neuropsychological tests (cognitive domains memory, executive function, and language).
  
  
  RESULTS
  Mild, moderate, or severe cognitive impairment, classified according to a previously designed algorithm.
  
  
  RESULTS
  Of the peritoneal dialysis cohort, 33.3% had no or mild, 35.3% had moderate, and 31.4% had severe cognitive impairment; corresponding values were 60.4%, 26.7%, and 12.9% of the non-CKD cohort and 26.6%, 36.4%, and 37.0% of the hemodialysis cohort. A logistic regression model including age, sex, race, education, hemoglobin level, diabetes, and stroke showed that only nonwhite race (P = 0.002) and low education (P = 0.002) were associated with moderate to severe cognitive impairment in the peritoneal dialysis cohort. Compared with hemodialysis patients, more peritoneal dialysis patients had moderate to severe memory impairment (58% vs 51%), but fewer had impaired executive function (one-third vs one-half). Peritoneal dialysis was associated with a more than 2.5-fold increased risk of moderate to severe global cognitive impairment compared with no CKD (OR, 2.58; 95% CI, 1.02-6.53), as was hemodialysis (OR, 3.16; 95% CI, 1.91-5.24), in an adjusted logistic regression model.
  
  
  CONCLUSIONS
  Small sample size, participation rate somewhat low.
  
  
  CONCLUSIONS
  Similar to hemodialysis patients, two-thirds of peritoneal dialysis patients had moderate to severe cognitive impairment, enough to interfere with safely self-administering dialysis and adhering to complex medication regimens. These patients could benefit from cognitive assessment before and periodically after dialysis therapy initiation.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, and University of Minnesota, Minneapolis, MN 55404, USA.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Kalirao
authors.forename: Sarah
authors.initials: S
authors.lastname: Pederson
authors.forename: Robert N
authors.initials: RN
authors.lastname: Foley
authors.forename: Ali
authors.initials: A
authors.lastname: Kolste
authors.forename: David
authors.initials: D
authors.lastname: Tupper
authors.forename: David
authors.initials: D
authors.lastname: Zaun
authors.forename: Vanessa
authors.initials: V
authors.lastname: Buot
authors.forename: Anne M
authors.initials: AM
authors.lastname: Murray
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002908:Chronic Disease; D003072:Cognition Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000523:psychology* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010530:Peritoneal Dialysis; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index