Cognitive Impairment Predicts Adverse Outcomes in CKD.
Cognitive impairment (CI) affects self-management in chronic diseases, leading to poor decision-making, delayed care, and increased mortality. The specific impact of CI on adverse outcomes in chronic kidney disease (CKD) remains poorly explored.
The French CKD - Renal Epidemiology and Information Network (CKD-REIN) cohort included 3033 patients with CKD stage 2 to 5 and 5 years of follow-up. CI was assessed using the Mini-Mental State Examination (MMSE), and estimated glomerular filtration rate (eGFR) was estimated using the CKD Epidemiology Collaboration creatinine equation. Cox models evaluated the risks of all-cause mortality, kidney replacement therapy (KRT) initiation, and major adverse cardiovascular (CV) events (MACEs).
A total of 3004 patients were included in the analysis (mean age: 67 years, mean eGFR: 34 ml/min per 1.73 m2), and 64%, 23%, and 13%, respectively had MMSE scores > 26, from 24 to 26, and < 24 at baseline. During the follow-up period (mean: 3.87 years), 21.5% of patients initiated KRT, 13.4% died, and 15.3% experienced a MACE before KRT or non-CV death. In adjusted Cox models, patients with a MMSE < 24 had a higher risk of clinical adverse outcome, relative to those with a MMSE > 26: hazard ratio (HR) [95% confidence interval] was 1.42 [1.12-1.81], 1.57 [1.19-2.07], and 1.32 [1.02-1.70] for KRT initiation, all-cause mortality, and MACE, respectively. In addition, CI was associated with all-cause mortality in the MMSE of 24 to 26 group (HR: 1.45, 95% confidence interval: 1.15-1.83).
In CKD, a baseline MMSE score < 24 predicts higher overall-death, KRT initiation, and MACEs, relative to a baseline score > 26. These results highlight CI's prognostic value, and suggest that earlier detection could better personalize management, particularly for kidney and CV complications.
The French CKD - Renal Epidemiology and Information Network (CKD-REIN) cohort included 3033 patients with CKD stage 2 to 5 and 5 years of follow-up. CI was assessed using the Mini-Mental State Examination (MMSE), and estimated glomerular filtration rate (eGFR) was estimated using the CKD Epidemiology Collaboration creatinine equation. Cox models evaluated the risks of all-cause mortality, kidney replacement therapy (KRT) initiation, and major adverse cardiovascular (CV) events (MACEs).
A total of 3004 patients were included in the analysis (mean age: 67 years, mean eGFR: 34 ml/min per 1.73 m2), and 64%, 23%, and 13%, respectively had MMSE scores > 26, from 24 to 26, and < 24 at baseline. During the follow-up period (mean: 3.87 years), 21.5% of patients initiated KRT, 13.4% died, and 15.3% experienced a MACE before KRT or non-CV death. In adjusted Cox models, patients with a MMSE < 24 had a higher risk of clinical adverse outcome, relative to those with a MMSE > 26: hazard ratio (HR) [95% confidence interval] was 1.42 [1.12-1.81], 1.57 [1.19-2.07], and 1.32 [1.02-1.70] for KRT initiation, all-cause mortality, and MACE, respectively. In addition, CI was associated with all-cause mortality in the MMSE of 24 to 26 group (HR: 1.45, 95% confidence interval: 1.15-1.83).
In CKD, a baseline MMSE score < 24 predicts higher overall-death, KRT initiation, and MACEs, relative to a baseline score > 26. These results highlight CI's prognostic value, and suggest that earlier detection could better personalize management, particularly for kidney and CV complications.
Authors
Levassort Levassort, Hassan Hassan, Boucquemont Boucquemont, Liabeuf Liabeuf, Laville Laville, Lange Lange, Alencar de Pinho Alencar de Pinho, Massy Massy, Pépin Pépin,
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