Cognitive Impairment is Associated with Mortality in Hemodialysis Patients

Article type: Research Article

Authors: Angermann, Susanne^{a; 1; *} | Schier, Johannes^{a; 1} | Baumann, Marcus^b | Steubl, Dominik^a | Hauser, Christine^a | Lorenz, Georg^a | Günthner, Roman^a | Braunisch, Matthias C.^a | Kemmner, Stephan^a | Satanovskij, Robin^a | Haller, Bernhard^c | Heemann, Uwe^a | Lehnert, Thomas^d | Bieber, Richard^e | Pachmann, Martin^f | Braun, Jürgen^g | Scherf, Julia^h | Schätzle, Gabriele^h | Fischereder, Michaelⁱ | Grimmer, Timo^{j; 1} | Schmaderer, Christoph^{a; 1; *}

Affiliations: [a] Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany | [b] Department of Nephrology, Klinikum Ansbach, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nuremberg, Germany | [c] Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany | [d] Dialysezentrum München Nord, Munich, Germany | [e] Nierenzentrum24 München, Munich, Germany | [f] DiZ München Nephrocare GmbH, Munich, Germany | [g] Praxen Dr. Braun, Dingolfing, Germany | [h] KfH-Nierenzentrum München-Giesing, Munich, Germany | [i] Department of Nephrology, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany | [j] Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

Correspondence: [*] Correspondence to: Susanne Angermann and Christoph Schmaderer, Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Bavaria, Germany. Tel.: +49 89 4140 5235; Fax: +49 89 4140 4817; E-mails: susanne.angermann@mri.tum.de (S. Angermann) and christoph.schmaderer@mri.tum.de (C. Schmaderer).

Note: [1] These authors contributed equally to this work.

Abstract: Background:The prevalence of cognitive impairment in hemodialysis patients is notably high. In previous studises performed in the general population, cognitive impairment has been associated with increased mortality. Objective:We evaluated the relationship between global cognitive function tested by a short screening instrument and mortality in hemodialysis patients. Methods:Cognitive testing was performed in 242 maintenance hemodialysis patients under standardized conditions at baseline using the Montreal Cognitive Assessment (MoCA).Cognitive impairment was defined as a MoCA test score ≤24 points, as published previously. All-cause mortality was monitored during a median follow-up of 3.54 years. Kaplan-Meier plot and Cox regression model adjusted for known risk factors for mortality in hemodialysis patients were used to examine a possible association between global cognitive function and all-cause mortality. Results:A MoCA test score ≤24 points resulted in a significant almost 3-fold higher hazard for all-cause mortality (unadjusted hazard ratio [HR]: 2.812; 95% confidence interval [95% CI]: 1.683–4.698; p < 0.001). After adjustment, this association was attenuated but remained significant (adjusted HR: 1.749; 95% CI: 1.007–3.038; p = 0.047). Conclusion:Impairment of global cognitive function measured by a short screening instrument was identified for the first time as an independent predictor of all-cause mortality in hemodialysis patients. Thus, implementing the MoCA test in clinical routine could contribute to a better risk stratification of this patient population.

Keywords: Cognitive dysfunction, hemodialysis, Montreal Cognitive Assessment, mortality

DOI: 10.3233/JAD-180767

Journal: Journal of Alzheimer's Disease, vol. 66, no. 4, pp. 1529-1537, 2018