title: Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients.
abstract: BACKGROUND
  Cognitive impairment is common in patients treated with hemodialysis. The trajectory of cognitive function and risk factors for cognitive decline remain uncertain in this population.
  
  
  METHODS
  Longitudinal cohort.
  
  
  METHODS
  314 prevalent hemodialysis patients.
  
  
  METHODS
  Age, sex, race, education level, hemodialysis vintage, cause of end-stage renal disease, and baseline history of cardiovascular disease.
  
  
  RESULTS
  Cognitive function as determined by a comprehensive neurocognitive battery, administered at baseline and yearly when possible. Individual cognitive test results were reduced into 2 domain scores using principal components analysis, representing memory and executive function, which were used as our coprimary outcomes and by definition have a mean of zero and SD of 1.
  
  
  RESULTS
  Mean age was 63 years; 54% were men, 22% were black, and 90% had at least a high school education. During a median follow-up of 2.1 (IQR, 0.9-4.2) years, 196 had at least 1 follow-up test, 156 died, and 43 received a kidney transplant. Linear mixed models and joint models, which accounted for competing risks from death, dropout, or kidney transplantation, showed nearly identical results. The joint model demonstrated a decline in executive function (-0.09 [95% CI, -0.13 to -0.05] SD per year), whereas memory improved slightly (0.05 [95% CI, 0.02 to 0.08] SD per year). A significant yearly decline was also seen in the Mini-Mental State Examination score (median change, -0.41; 95% CI, -0.57 to -0.25). Older age was the only significant risk factor for steeper executive function decline (-0.04 [95% CI, -0.06 to -0.02] SD steeper annual decline for each 10 years of age).
  
  
  CONCLUSIONS
  Prevalent hemodialysis patients only, limited follow-up testing due to high mortality rate, and exclusion of participants with severe cognitive deficits or dementia.
  
  
  CONCLUSIONS
  Prevalent hemodialysis patients demonstrate significant cognitive decline, particularly within tests of executive function. Older age was the only statistically significant risk factor for steeper cognitive decline, which may have important clinical consequences for patient management and education. Future studies should evaluate strategies to maintain or improve cognitive function.
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA. Electronic address: ddrew@tuftsmedicalcenter.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Drew
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Duncan
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Aditi
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Scott
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D056344:Executive Function; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008609:Mental Status Schedule; D008875:Middle Aged; D009026:Mortality; D010352:Patient Dropouts; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: Cognitive impairment; cardiovascular disease (CVD); cognitive decline; disease progression; end-stage renal disease (ESRD); executive function; hemodialysis; kidney disease cerebrovascular neuropathology; memory; neurocognitive battery; risk factor