title: Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Cognitive impairment is associated with poorer quality of life, risk for hospitalization, and mortality. Cognitive impairment is common in people with end-stage kidney disease treated with hemodialysis, yet the severity and specific cognitive deficits are uncertain.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Adults receiving hemodialysis compared with the general population, people with non-dialysis-dependent chronic kidney disease (NDD-CKD), people receiving peritoneal dialysis, or people with nondialyzed chronic kidney failure.
  
  
  METHODS
  Randomized controlled trials, cohort or cross-sectional studies without language restriction.
  
  
  METHODS
  Validated neuropsychological tests of cognition.
  
  
  RESULTS
  Cognitive test scores, aggregated by cognitive domain: orientation and attention, perception, memory, language, construction and motor performance, concept formation and reasoning, and executive functions.
  
  
  RESULTS
  42 studies of 3,522 participants. Studies were of high or uncertain risk of bias, assessed by the Newcastle-Ottawa Scale. People treated with hemodialysis had worse cognition than the general population, particularly in attention (n=22; standardized mean difference [SMD], -0.93; 95% CI, -1.18 to -0.68). Hemodialysis patients performed better than nondialyzed patients with chronic kidney failure in attention (n=6; SMD, 0.70; 95% CI, 0.45 to 0.96) and memory (n=6; SMD, 0.36; 95% CI, 0.08 to 0.63), but had poorer memory than the general population (n=16; SMD, -0.41; 95% CI, -0.91 to 0.09) and people with NDD-CKD (n=5; SMD, -0.40; 95% CI, -0.60 to -0.21). There were insufficient data to show other differences among people receiving hemodialysis and those receiving peritoneal dialysis or with NDD-CKD.
  
  
  CONCLUSIONS
  Potentially biased studies, not wholly adjusted for education. High heterogeneity, mainly due to the large variety of tests used to assess cognition.
  
  
  CONCLUSIONS
  People treated with hemodialysis have impaired cognitive function compared to the general population, particularly in the domains of orientation and attention and executive function. Cognitive deficits in specific domains should be further explored in this population and should be considered when approaching education and chronic disease management.
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. Electronic address: eolo0909@uni.sydney.edu.au.
authors.forename: Emma
authors.initials: E
authors.lastname: O'Lone
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia; ARC Centre of Excellence in Cognition and Its Disorders, Sydney, Australia; Department of Cognitive Science, Macquarie University, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Connors
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Masson
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Sunny
authors.initials: S
authors.lastname: Wu
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kelly
authors.affiliation: University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.affiliation: Desert AIDS Project, Palm Springs, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Parker
authors.affiliation: University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Whiteley
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; University of Bari, Bari, Italy; Diaverum Academy, Lund, Sweden.
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
authors.affiliation: University of Otago Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead, Sydney, Australia.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Webster
mesh_terms: D003072:Cognition Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D006435:Renal Dialysis
keywords: Cognition; RRT modality; attention; chronic disease management; cognitive impairment; end-stage kidney disease (ESKD); executive function; hemodialysis; memory; meta-analysis; neuropsychological tests; orientation; renal replacement therapy (RRT); systematic review