Stroke, mental disorders factor in cognitive impairment in CKD

Some patients with chronic kidney disease (CKD) develop cognitive impairment, with risk factors including previous stroke, depression or anxiety, higher proteinuria, and prescription of psychodynamic medications, a study reports.

The study included 250 patients (median age, 55 years) who underwent two cognitive assessments: Montreal Cognitive Assessment (MoCA) and Trail Making Test (TMT). According to MoCA, 111 (44.4 percent) patients were cognitively impaired while 62 (24.8 percent) suffered relative cognitive impairment. Based on TMT results, 18 patients (7.2 percent) had cognitive impairment while six had relative cognitive impairment.

Patients with normal cognitive performance (n=127) had significantly better renal function (median estimated glomerular filtration rate [eGFR], 39 mL/min/ 1.73 m²) and markedly lower proteinuria (median, 28 mg/mmol) relative to those who scored poorly on either MoCA or TMT.

 Meanwhile, patients identified with cognitive impairment were older, more likely to be retired or widowed, and suffer/had suffered from atrial fibrillation, peripheral vascular disease, myocardial infarction, stroke, or coronary heart disease.

In multivariable logistical regression models, depression, previous stroke, and older age conferred a risk increase for cognitive impairment. Relative cognitive impairment, on the other hand, was associated with older age (p≤0.05) and higher proteinuria and the use of psychodynamic medications (p=0.05).

Changes seen in eGFR did not significantly differ between patients with cognitive impairment and relative cognitive impairment and those with normal cognition (−0.77 vs −1.35 mL/min/1.73 m²/year; p=0.34 and −1.12 vs −1.02 mL/min/1.73 m²/year; p=0.89, respectively).

The present data indicate that faster eGFR decline is not associated with the presence of cognitive impairment in patients with moderate to severe non-dialysis CKD.