title: Prevalence of CMMSE defined cognitive impairment among peritoneal dialysis patients and its impact on peritonitis.
abstract: BACKGROUND
  Peritoneal dialysis (PD) exchange procedure is complex. Patients with cognitive impairment (CI) may require assistance. We studied the prevalence of CI among PD patients, its impact on PD-related peritonitis and the outcome of assisted PD.
  
  
  METHODS
  Cantonese version of Mini-Mental State examination (CMMSE) was performed in 151 patients newly started on PD. Data on patient characteristics including demographics, co-morbidities, blood parameters, medications, and number of PD-related peritonitis in the first 6 months were collected.
  
  
  RESULTS
  151 subjects were recruited. The age of studied patients was 60 ± 15.0 years, and 45% were female. The prevalence of CI was 13.9% using education-adjusted cut-off of CMMSE. Patients older than 65-year-old, female, and lower education level were independent risk factors for CI (OR 9.27 p = 0.001, OR 14.84 p = 0.005, and OR 6.10 p = 0.009, respectively). Age greater than 65-year old is an independent risk factor for PD-related peritonitis but CI was not. Patients requiring assisted PD were of older age (p < 0.001), lower CMMSE (p < 0.001), and scored higher for age-adjusted Charlson Co-morbidity index (p < 0.001). Compared with self-care PD patients, assisted PD patients did not have higher rates exit site infection (p = 0.30) but had a trend of higher PD peritonitis (p = 0.07).
  
  
  CONCLUSIONS
  CI is common among local PD patients. Overall, CI could not be identified as an independent risk factor for PD peritonitis. There is a higher prevalence of CI among assisted PD patients but helpers may not completely eliminate the risk of PD-related peritonitis.
authors.affiliation: Division of Geriatrics, Department of Medicine LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong 102 Pokfulam Road, Hong Kong SAR, China. elphashea@gmail.com.
authors.forename: Yat Fung
authors.initials: YF
authors.lastname: Shea
authors.affiliation: Division of Nephrology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Man-Fai
authors.initials: MF
authors.lastname: Lam
authors.affiliation: Department of Occupation Therapy, Queen Mary Hospital, Hong Kong, China.
authors.forename: Mi Suen Connie
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Ming Yee Maggie
authors.initials: MY
authors.lastname: Mok
authors.affiliation: Division of Nephrology, Department of Medicine, Tung Wah Hospital, Hong Kong, China.
authors.forename: Sing-Leung
authors.initials: SL
authors.lastname: Lui
authors.affiliation: Division of Nephrology, Department of Medicine, Tung Wah Hospital, Hong Kong, China.
authors.forename: Terence P S
authors.initials: TP
authors.lastname: Yip
authors.affiliation: Division of Nephrology, Department of Medicine, Tung Wah Hospital, Hong Kong, China.
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Lo
authors.affiliation: Division of Geriatrics, Department of Medicine LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong 102 Pokfulam Road, Hong Kong SAR, China.
authors.forename: Leung Wing
authors.initials: LW
authors.lastname: Chu
authors.affiliation: Division of Nephrology, Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Tak-Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012648:Self Care; D016896:Treatment Outcome
keywords: Cognitive impairment; Peritoneal dialysis; Peritonitis