Cognitive Testing in Patients with CKD: The Problem of Missing Cases.
OBJECTIVE
Cognitive testing is only valid in individuals with sufficient visual and motor skills and motivation to participate. Patients on dialysis usually suffer from limitations, such as impaired vision, motor difficulties, and depression. Hence, it is doubtful that the true value of cognitive functioning can be measured without bias. Consequently, many patients are excluded from cognitive testing. We focused on reasons for exclusion and analyzed characteristics of nontestable patients.


METHODS
Within the Choice of Renal Replacement Therapy Project (baseline survey: May 2014 to May 2015),n=767 patients on peritoneal dialysis (n=240) or hemodialysis (n=527) were tested with the Trail Making Test-B and the German d2-Revision Test and completed the Kidney Disease Quality of Life Short Form cognition subscale. We divided the sample into patients with missing cognitive testing data and patients with full cognitive testing data, analyzed reasons for nonfeasibility, and compared subsamples with regard to psychosocial and physical metrics. The exclusion categories were linked to patient characteristics potentially associated with missing data (age, comorbidity, depression, and education level) by calculation ofλ-coefficient.


RESULTS
The subsamples consisted ofn=366 (48%) patients with missing data (peritoneal dialysis =62, hemodialysis =304) andn=401 patients with full cognitive testing data (peritoneal dialysis =178, hemodialysis =223). Patients were excluded due to visual impairment (49%), lack of motivation (31%), and motor impairment (13%). The remaining 8% did not follow instructions, suffered from medical incidents, or had language difficulties. Compared with patients with full cognitive testing data, they were more likely to have depression; be treated with hemodialysis; be older, nonworking, or more comorbid; and experience poorer shared decision making. Reasons for exclusion were not related to levels of age, comorbidity score, depression score, or education level.


CONCLUSIONS
We excluded almost one half of eligible patients from cognitive testing due to visual, motivational, or motor difficulties. Our findings are consistent with exclusion categories reported from the literature. We should be aware that, because of disease-related limitations, conclusions about cognitive functioning in the CKD population may be biased. In the future, nonvisual and nonverbal cognitive testing can be a valuable resource.
Institute for Rehabilitation Medicine.|Center for Health Sciences, and.
Denise
D
Neumann
Institute for Rehabilitation Medicine.|Center for Health Sciences, and.
Maxi
M
Robinski
Institute for Rehabilitation Medicine.|Center for Health Sciences, and.
Wilfried
W
Mau
Center for Health Sciences, and.|Department of Internal Medicine II, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Matthias
M
Girndt
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003144:Communication Barriers; D015897:Comorbidity; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D000073216:Mental Status and Dementia Tests; D008875:Middle Aged; D009042:Motivation; D000068079:Motor Disorders / Q000150:complications; D010349:Patient Compliance; D018579:Patient Selection; D010530:Peritoneal Dialysis; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D051436:Renal Insufficiency, Chronic / Q000523:psychology* / Q000628:therapy*; D014145:Trail Making Test; D014478:Unemployment; D014786:Vision Disorders / Q000150:complications
CORETH; Case Exclusion; Cognition; Cognitive Functioning; Comorbidity; ESRD; Health Resources; Humans; Language; Motivation; Motor Skills; Neurocognition; Preclusion; Renal Insufficiency, Chronic; Surveys and Questionnaires; Trail Making Test; Vision Disorders; depression; hemodialysis; peritoneal dialysis; renal dialysis