Advertisement

International Urology and Nephrology

, Volume 50, Issue 8, pp 1505–1510 | Cite as

Kidney function and cognitive decline in frail elderly: two faces of the same coin?

  • Giuseppe Coppolino
  • Davide Bolignano
  • Pietro Gareri
  • Carmen Ruberto
  • Michele Andreucci
  • Giovanni Ruotolo
  • Maurizio Rocca
  • Alberto Castagna
Nephrology - Original Paper

Abstract

Background and aims

Cognitive and renal impairment are pervasive among elderly frails, a high-risk, geriatric sub-population with peculiar clinical characteristics. In a series of frail individuals with non-advanced chronic kidney disease (CKD), we aimed at assessing the entity of functional, general health and cognitive impairment and the possible relationship between these types of dysfunction and the severity of renal impairment.

Methods

2229 geriatric subjects were screened for frailty and CKD. Severity of CKD was assessed by eGFR (CKD-EPI formula). Frailty was established by the Fried Index. Functional, general health and cognitive status were assessed by validated score measures.

Results

Final analysis included 271 frail CKD subjects (162 women, 109 men). Mean eGFR was 64.25 ± 25.04 mL/min/1.73 m2. Prevalence of mild-to-moderate CKD (stage 3–4) was 44%. Twenty-six percent of patients had severe cognitive impairment, while mild and moderate impairment was found in 7 and 67% of individuals, respectively. All subjects had poor functional and general health status. Cognitive capacities significantly decreased across CKD stages (p for trend < 0.0001). In fully adjusted multivariate analyses, cognitive status remained an independent predictor of eGFR (β = 0.465; p < 0.0001).

Conclusions

Mild-to-moderate CKD is highly pervasive among frail elderly individuals and the severity of renal dysfunction is independently correlated with that of cognitive impairment. Future studies are advocated to clarify whether the combination of kidney and mental dysfunction may portend a higher risk of worsen outcomes in this high-risk population.

Keywords

Frailty CKD Cognitive GFR 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Bolignano D, Mattace-Raso F, Sijbrands EJ, Zoccali C (2014) The aging kidney revisited: a systematic review. Ageing Res Rev 14:65–80CrossRefPubMedGoogle Scholar
  2. 2.
    Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298:2038–2047CrossRefPubMedGoogle Scholar
  3. 3.
    Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 41:1–12CrossRefPubMedGoogle Scholar
  4. 4.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A 56:M146–M156CrossRefGoogle Scholar
  5. 5.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dalrymple LS, Katz R, Rifkin DE, Siscovick D, Newman AB et al (2013) Kidney function and prevalent and incident frailty. Clin J Am Soc Nephrol 8:2091–2099CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Shlipak MG, Stehman-Breen C, Fried LF, Song X, Siscovick D et al (2004) The presence of frailty in elderly persons with chronic renal insufficiency. Am J Kidney Dis 43:861–867CrossRefPubMedGoogle Scholar
  8. 8.
    Roshanravan B, Khatri M, Robinson-Cohen C, Levin G, Patel KV et al (2012) A prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis 60:912–921CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Foster R, Walker S, Brar R, Hiebert B, Komenda P et al (2016) Cognitive impairment in advanced chronic kidney disease: the Canadian Frailty Observation and Interventions Trial. Am J Nephrol 44:473–480CrossRefPubMedGoogle Scholar
  10. 10.
    Kurella Tamura M, Yaffe K, Hsu CY, Yang J, Sozio S et al (2016) Cognitive impairment and progression of CKD. Am J Kidney Dis 68:77–83CrossRefPubMedGoogle Scholar
  11. 11.
    Vermeiren S, Vella-Azzopardi R, Beckwee D, Habbig AK, Scafoglieri A et al. (2016) Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc 17:1163 e1161–1163 e1117CrossRefGoogle Scholar
  12. 12.
    National Kidney F (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1-266Google Scholar
  13. 13.
    Farrington K, Covic A, Aucella F, Clyne N, de Vos L et al (2016) Clinical practice guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR < 45 mL/min/1.73 m2). Nephrol Dial Transplant 31:ii1–ii66CrossRefPubMedGoogle Scholar
  14. 14.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  15. 15.
    Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M (1996) Mini-Mental State Examination: a normative study in Italian elderly population. Eur J Neurol 3:198–202CrossRefPubMedGoogle Scholar
  16. 16.
    Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10:20–30CrossRefPubMedGoogle Scholar
  17. 17.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186CrossRefPubMedGoogle Scholar
  18. 18.
    Parmelee PA, Thuras PD, Katz IR, Lawton MP (1995) Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 43:130–137CrossRefPubMedGoogle Scholar
  19. 19.
    Esposito C, Plati A, Mazzullo T, Fasoli G, De Mauri A et al (2007) Renal function and functional reserve in healthy elderly individuals. J Nephrol 20:617–625PubMedGoogle Scholar
  20. 20.
    Coppolino G, Presta P, Saturno L, Fuiano G (2013) Acute kidney injury in patients undergoing cardiac surgery. J Nephrol 26:32–40CrossRefPubMedGoogle Scholar
  21. 21.
    Leporini C, Pisano A, Russo E, D’Arrigo G, de Sarro G, et al (2016) Effect of pentoxifylline on renal outcomes in chronic kidney disease patients: a systematic review and meta-analysis. Pharmacol Res 107:315–332CrossRefPubMedGoogle Scholar
  22. 22.
    Buemi M, Coppolino G, Bolignano D, Sturiale A, Campo S et al (2009) Arrhythmias and hemodialysis: role of potassium and new diagnostic tools. Ren Fail 31:75–80CrossRefPubMedGoogle Scholar
  23. 23.
    Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham JL et al (2016) Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med 165:473–481CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Coppolino G, Campo S, Crasci E, Aloisi C, Giacobbe MS et al (2008) Neurobiological model and quality of life in discovering personality of the uremic patient. J Nephrol 21(Suppl 13):S139–S145PubMedGoogle Scholar
  25. 25.
    Buemi M, Caccamo C, Floccari F, Coppolino G, Tripodo D et al (2003) Correlation between quality of life assessment and a personality neurobiologic model in dialyzed patients. J Nephrol 16:895–902PubMedGoogle Scholar
  26. 26.
    Hayes TL, Larimer N, Adami A, Kaye JA (2009) Medication adherence in healthy elders: small cognitive changes make a big difference. J Aging Health 21:567–580CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Buemi M, Lacquaniti A, Bolignano D, Donato V, Fazio MR et al (2008) Dialysis and the elderly: an underestimated problem. Kidney Blood Press Res 31:330–336CrossRefPubMedGoogle Scholar
  28. 28.
    Bolignano D, Coppolino G, Romeo A, Lacquaniti A, Buemi M (2010) Neutrophil gelatinase-associated lipocalin levels in chronic haemodialysis patients. Nephrology 15:23–26CrossRefPubMedGoogle Scholar
  29. 29.
    Berger I, Wu S, Masson P, Kelly PJ, Duthie FA et al (2016) Cognition in chronic kidney disease: a systematic review and meta-analysis. BMC Med 14:206CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kurella Tamura M, Muntner P, Wadley V, Cushman M, Zakai NA et al (2011) Albuminuria, kidney function, and the incidence of cognitive impairment among adults in the United States. Am J Kidney Dis 58:756–763CrossRefPubMedGoogle Scholar
  31. 31.
    Yaffe K, Ackerson L, Kurella Tamura M, Le Blanc P, Kusek JW et al (2010) Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc 58:338–345CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nephrology and Dialysis Unit“Pugliese-Ciaccio” General HospitalCatanzaroItaly
  2. 2.Institute of Clinical PhysiologyCNR - Italian National Council of ResearchReggio CalabriaItaly
  3. 3.Geriatric Unit“Pugliese-Ciaccio” General HospitalCatanzaroItaly
  4. 4.Renal Unit, Department of Health Sciences“Magna Graecia” UniversityCatanzaroItaly
  5. 5.Center for Cognitive Disorders and DementiaAzienda Sanitaria Provinciale di CatanzaroCatanzaroItaly

Personalised recommendations