title: Loss of executive function after dialysis initiation in adults with chronic kidney disease.
abstract: The association of dialysis initiation with changes in cognitive function among patients with advanced chronic kidney disease is poorly described. To better define this, we enrolled participants with advanced chronic kidney disease from the Chronic Renal Insufficiency Cohort in a prospective study of cognitive function. Eligible participants had a glomerular filtration rate of 20 ml/min/1.73m2or less, or dialysis initiation within the past two years. We evaluated cognitive function by a validated telephone battery at regular intervals over two years and analyzed test scores as z scores. Of 212 participants, 123 did not transition to dialysis during follow-up, 37 transitioned to dialysis after baseline, and 52 transitioned to dialysis prior to baseline. In adjusted analyses, the transition to dialysis was associated with a significant loss of executive function, but no significant changes in global cognition or memory. The estimated net difference in cognitive z scores at two years for participants who transitioned to dialysis during follow-up compared to participants who did not transition to dialysis was -0.01 (95% confidence interval -0.13, 0.11) for global cognition, -0.24 (-0.51, 0.03) for memory, and -0.33 (-0.60, -0.07) for executive function. Thus, among adults with advanced chronic kidney disease, dialysis initiation was associated with loss of executive function with no change in other aspects of cognition. Larger studies are needed to evaluate cognition during dialysis initiation.
authors.affiliation: VA Palo Alto Geriatric Research and Education Clinical Center, Palo Alto, California, USA; Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA. Electronic address: mktamura@stanford.edu.
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: VA Palo Alto Geriatric Research and Education Clinical Center, Palo Alto, California, USA.
authors.forename: Karman
authors.initials: K
authors.lastname: Tam
authors.affiliation: Department of Medicine, Division of Nephrology, University of Maryland, Baltimore, Maryland, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.affiliation: Division of Nephrology, Johns Hopkins University School of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research; Baltimore, Maryland, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sozio
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC and Edward Hines, Jr. VA, and University of Illinois Hospital and Health Sciences System; Chicago, Illinois, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department of Medicine, Tulane University School of Medicine; New Orleans, Louisiana, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Medicine, Tulane University School of Medicine; New Orleans, Louisiana, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Lustigova
authors.affiliation: Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Strauss
authors.affiliation: Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Division of Research, Kaiser Permanente Northern California; Oakland, California, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA; Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
mesh_terms: D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D056344:Executive Function; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: CKD; cognitive function; dialysis