Egbi et al
Greener Journal of Medical Sciences Vol. 5 (1), pp. 019-025, January 2015.
ISSN: 2276-7797 © 2015 Greener Journals
Manuscript Number: 051114384
Cognitive deficits of patients with chronic kidney disease and effect of hemodialysis
Oghenekaro Godwin Egbi1*, Olubunmi Ogunrin2 and Efosa Oviasu2
1Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria.
2Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Corresponding Author’s Email: drkoge@ yahoo. com
Background: Cognitive impairment (CI) has been described in chronic kidney disease (CKD) but the effect of haemodialysis (HD) on cognitive performance of CKD patients has not been researched in Sub-Saharan Africa. We studied the cognitive deficits of CKD patients and the short-term effect of HD on cognitive function in end-stage renal disease (ESRD) patients.
Methods: This was a case-controlled analytical study of one hundred and ninety CKD patients and a hundred control subjects recruited and neuro-psychologically assessed with a computer assisted test battery, the Iron Psychology (acronym – FePsy) pre- and post-hemodialysis.
The study was conducted between December 2009 and July 2010 at a tertiary health facility in cosmopolitan southern Nigeria and involved consecutive patients with clinical evidence of CKD based on symptoms and estimated GFR. Demographic, clinical and biochemical variables were related to cognitive performance using Pearson correlation and multiple regression analysis. The outcome measures were scores of psychomotor speed tasks (simple auditory and visual reaction times), recognition memory tests and sustained attention task (binary choice task). The Iron Psychology (FePsy) was used to assess the simple reaction time, complex reaction time, memory and concentration of the CKD patients and controls.
Results: CKD patients performed worse in tasks of information processing speed and memory but compared favorably with controls in tests of concentration. Advancing age, anemia, uncontrolled systolic blood pressure, acidosis and serum chloride derangement were independently associated with cognitive deficits. Acute HD was only associated with improvement in psychomotor speed.
Conclusion: The CKD patients manifested cognitive impairments in memory and psychomotor tasks. Anemia, uncontrolled blood pressure and biochemical derangements predicted cognitive impairment. HD, in the short term, improved psychomotor speed of the patients.
Keywords: chronic kidney disease, cognitive impairment, endstage renal disease, hemodialysis, iron psychology.
Atti AR, Palmer K, Volpato S, Zuliani G, Winblad B, Fratiglioni L (2006). Anaemia increases the risk of dementia in cognitively impaired intact elderly. Neurobiol Aging; 2: 278-284.
De Groot JC, de Leeuw FE, Oudkerk M et al. (2000). Cerebral white matter lesions and cognitive function: The Rotterdam Scan Study. Ann Neurol.; 47:145–151.
Elias MF, Elias PK, SeligerSL (2009). Chronic kidney disease, creatinine and cognitive functioning. Nephrol Dial Transplant.; 24 (8): 2446-2452.
Elias PK, Elias MF, Robbins MA, Budge MM (2004). High blood pressure related decline in cognitive function. Hypertension; 44:631-636.
Fazekas G, Fazekas F, Schmidt R et al.(1995). Brain MRI findings and cognitive impairment in patients undergoing chronic hemodialysis treatment. J Neurol Sci;134:83–88.
Griva K, Thompson D, Jayasena D et al (2006) Cognitive functioning pre- to post-kidney
transplantation-a prospective study. Nephrol Dial Transplant; 21:3275-3282
Hailpern SM, Melamed ML, Cohen HW, et al.(2007). Moderate chronic kidney disease and cognitive function in adults 20 to 59 years of age: Third National Health and Nutrition Examination Survey (NHANES III). J Am Soc Nephrol; 18:2205-2213.10.
Goldman SA, Pulsinelli WA, Clarke WY, Kraig RP, Plum F. The effect of extracellular acidosis on neurons and glia in vitro. J Cereb Blood Flow Metab 1989; 9(4):471-477.
Hart RP, Pederson JA, Czerwinski AW et al (1983). Chronic renal failure, dialysis, and neuropsychological function. J Clin Neuropsychol; 5:301-312.
Ikram MA, Vernooij MW, Hofman A et al (2008). Kidney function is related to cerebral small vessel disease. Stroke; 39:55–61.
Kaufman P, Shungu DC, Sano MC et al. Kaufman P, Shungu DC, Sano MC et al. (2004). Cerebral lactic acidosis correlates with neurological impairment in MELAS. Neurology; 62:1297-1302.
Kurella M, Chertow GM, Luan J, et al. (2004). Cognitive impairment in chronic kidney disease. J Am Geriatr Soc; 52:1863-1869.
Kurella M, Chertow GM, Fried LF, et al.( 2005). Chronic kidney disease and cognitive impairment in the elderly: the health, aging and body composition study. J Am Soc Nephrol; 16:2127-2133.
Kurella M, Yaffe K, Shlipak MG et al. (2005); Chronic kidney disease and cognitive impairment in menopausal women. Am J Kidney Dis; 45:66-76.
Kuo HK, Sorond F, Iloputaife I, Gagnon M. (2004). Effect of blood pressure on cognitive function of elderly persons. J Gerontol A Biol Sci Med Sci; 59(11):1191-1194.33.
Kurella M, Yaffe K, Shlipak MG, et al.( 2005). Chronic kidney disease and cognitive impairment in menopausal women. Am J Kidney Dis 2005; 45:66-76.
Kurella TM, Wadley V, Yaffe MD et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis; 52:227-234.
Looi JC, Sachdev PS (1999). Differentiation of vascular dementia from AD on neuropsychological tests. Neurology; 53:670–678.
Madero M, Gul A, Sarnak MJ (2008). Cognitive function in chronic kidney disease. Semin Dial 21:29-37.
Martinez-Vea A, Salvado E, Bardaji A et al.(2006). Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged pre-dialysis patients with CKD. Am J Kidney Dis; 47:241–250.
Murray AM. (2008). Cognitive impairment in the Ageing dialysis and chronic kidney disease population: An occult burden. Am J Kid Dis;15(2):123-132.
Murray AM, Tupper DE, Knopman DS, et al.( 2006). Cognitive impairment in hemodialysis patients is common. Neurology; 67:216-223.
Murray AM, Pederson SI, Tupper DE et al (2007). Acute variation in cognitive function in hemodialysis patients. A cohort , with repeated measures. Am J Kidney Dis; 50:270-278.
Ogunniyi A, Hall KS, Gureje O. et al ( 2007). Cognitive decline and its determinants in a sample of elderly Yoruba. Proceedings of the Silver Congress of the International Psychogeriatric Association. Oct 14-18, Osaka, Japan. In: International Psychogeriatrics 19(S1):45-46.
Ogunrin OA, Adamolekun B. (2007). Cognitive Neuroassessment in Nigerian Africans- predictive validity of a computerized testing. Ann Biomed Sci; 6(1):28-44.
Ogunrin OA, Unuigbe IE.Azubike C (2006). Memory and perceptuo -motor performance in Nigerians with chronic renal impairment. Med Sci Monitor; 12(12): 535-539.
Pugh KG, Lipsitz LA. The microvascular frontal-subcortical syndrome of aging. Neurobiol Aging 2002; 23:421–431.
Roman GC, Royall DR(1999). Executive control function: a rational basis for the diagnosis of vascular dementia. Alzheimer Dis Assoc Disord.; 13(Suppl 3):S69–S80.
Sehgal AR, Grey SF, DeOreo PB, Whitehouse PJ (1997). Prevalence, recognition, and implications of mental impairment among hemodialysis patients. Am J Kidney Dis. 1997; 30:41–49.
Seliger SL, Longstreth WT Jr. (2008). Lessons about brain vascular disease from another pulsating organ, the kidney. Stroke; 39:5-6.
The psychological company. FePsy, a neuropsychological computerized test battery (2008) [cited 2009 Oct 08]; Available from: URL: http://www.fepsy.com.
Thornton WL, Shapiro RJ, Deria S, et al. 2007 Differential impact of age on verbal memory and executive functioning in chronic kidney disease. J Int Neuropsychol Soc; 13:344-353.
Umans JG, Pilskin NH (1998). Attention and mental processing speed in hemodialysis patients. Am J Kidney Dis 32(5):749-751.
Ylikoski R, Ylikoski A, Erkinjuntti T, Sulkava R, Raininko R, Tilvis R(1993). White matter changes in healthy elderly persons correlate with attention and speed of mental processing. Arch Neurol 50:818–824.