Functional and Cognitive Impairment in Advanced Kidney Disease
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Cognitive Studies, Renal Impairment / Chronic Kidney Disease |
| Therapuetic Areas: | Nephrology / Urology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 89 |
| Updated: | 4/21/2016 |
| Start Date: | December 2006 |
| End Date: | December 2016 |
An increasing number of Veterans are anticipated to develop chronic kidney disease (CKD) and
require hemodialysis (HD) treatments as the Veteran population ages. In 2003, approximately
290,000 US citizens were receiving HD and an estimated 19 million were affected by CKD. The
annual growth rate is predicted to be 7% per year with 500,000 Americans receiving HD
treatment by 2010. In 2005, approximately 2500 Veterans were receiving HD with growth
expected to parallel that seen in the general population. Whereas Alzheimer's disease is the
leading cause of dementia in the general population, growing evidence suggests that patients
with advanced CKD experience cognitive deficits related to accelerated cerebrovascular
disease. Patients with advanced CKD have been shown to have a high prevalence of
sub-clinical cerebrovascular damage on imaging studies and a heavy burden of vascular risk
factors such as diabetes, elevated cholesterol, and hypertension. Many of the cognitive
deficits related to cerebrovascular disease may go unrecognized by routine measures of
cognition. HD patients have increased number of hospitalizations, and several compliance
issues ranging from congestive heart failure to dangerous electrolyte imbalances. Impaired
cognition in this population is likely to have a significant impact on self-care and
compliance with complex medical regimens. Currently, the severity and scope of cognitive
impairment related to vascular disease is not well known in patients with advanced kidney
disease. Additionally, the relationship between cognitive impairment and measures of
self-care independence are not well known. Loss of independence and function secondary to
impaired cognitive function is likely to be a significant problem for patients with advanced
kidney disease. Early identification of functional impairment, particularly instrumental
activities of daily living (IADL), will allow for rehabilitation intervention. Maintaining
or improving functional independence through intensive rehabilitation could translate into
better compliance and lower hospitalization rate among HD patients. Information obtained
from this study is likely to heighten awareness of cognitive impairment and the functional
consequences in Veterans with advanced kidney disease. Primary objectives are to determine:
1. The range of cognitive deficits with emphasis on domains affected by vascular disease
in patients with advanced CKD and those receiving hemodialysis.
2. The associations between severity of cognitive impairment and severity of kidney
disease.
3. The prevalence of impaired IADLs and the level of health-related quality of life
(HRQOL) in patients with advanced CKD and those requiring hemodialysis.
4. The relationship or association of cognitive impairment with IADL and HRQOL.
Secondary objective is to determine:
1. The relationships among cerebral and carotid blood flow, carotid artery stiffness, and
renal specific metabolic abnormalities with cognitive impairment.
require hemodialysis (HD) treatments as the Veteran population ages. In 2003, approximately
290,000 US citizens were receiving HD and an estimated 19 million were affected by CKD. The
annual growth rate is predicted to be 7% per year with 500,000 Americans receiving HD
treatment by 2010. In 2005, approximately 2500 Veterans were receiving HD with growth
expected to parallel that seen in the general population. Whereas Alzheimer's disease is the
leading cause of dementia in the general population, growing evidence suggests that patients
with advanced CKD experience cognitive deficits related to accelerated cerebrovascular
disease. Patients with advanced CKD have been shown to have a high prevalence of
sub-clinical cerebrovascular damage on imaging studies and a heavy burden of vascular risk
factors such as diabetes, elevated cholesterol, and hypertension. Many of the cognitive
deficits related to cerebrovascular disease may go unrecognized by routine measures of
cognition. HD patients have increased number of hospitalizations, and several compliance
issues ranging from congestive heart failure to dangerous electrolyte imbalances. Impaired
cognition in this population is likely to have a significant impact on self-care and
compliance with complex medical regimens. Currently, the severity and scope of cognitive
impairment related to vascular disease is not well known in patients with advanced kidney
disease. Additionally, the relationship between cognitive impairment and measures of
self-care independence are not well known. Loss of independence and function secondary to
impaired cognitive function is likely to be a significant problem for patients with advanced
kidney disease. Early identification of functional impairment, particularly instrumental
activities of daily living (IADL), will allow for rehabilitation intervention. Maintaining
or improving functional independence through intensive rehabilitation could translate into
better compliance and lower hospitalization rate among HD patients. Information obtained
from this study is likely to heighten awareness of cognitive impairment and the functional
consequences in Veterans with advanced kidney disease. Primary objectives are to determine:
1. The range of cognitive deficits with emphasis on domains affected by vascular disease
in patients with advanced CKD and those receiving hemodialysis.
2. The associations between severity of cognitive impairment and severity of kidney
disease.
3. The prevalence of impaired IADLs and the level of health-related quality of life
(HRQOL) in patients with advanced CKD and those requiring hemodialysis.
4. The relationship or association of cognitive impairment with IADL and HRQOL.
Secondary objective is to determine:
1. The relationships among cerebral and carotid blood flow, carotid artery stiffness, and
renal specific metabolic abnormalities with cognitive impairment.
Inclusion Criteria:
PreHD Subjects:
- Male or female with an age of 18 years or older (no upper limit);
- Patients with stage III-IV CKD attending the renal primary care clinic or renal
consult clinic;
- Fluent in English;
- Outpatient or stable nursing home patient
HD Subjects:
- Receiving HD for at least two weeks;
- Male or female with an age of 18 years or older (no upper limit);
- Fluent in English;
- Outpatient or stable nursing home patient
Control Subjects:
- Glomerular filtration rate of 60 cc/minute or greater;
- Male or female with an age of 18y or older (no upper limit);
- Fluent in English
- Outpatient
Exclusion Criteria:
PreHD Subjects:
- Acute illness;
- Clinical history of stroke, dementia, or Parkinson's disease;
- Hb <10;
- Liver function tests 2x upper limit of normal;
- Hemodialysis
HD Subjects:
- Acute illness;
- Clinical history of stroke, dementia, or Parkinson's disease;
- Hb <10;
- Liver function tests 2x upper limit of normal;
- URR <65% (measure of dialysis adequacy: will use 3-month average from chart)
Control Subjects:
- Acute illness;
- Clinical history of stroke, dementia, or Parkinson's disease;
- Hb <10;
- Liver function tests 2x upper limit of normal;
- Stage 3-4 CKD;
- Hemodialysis
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