Cognitive Impairment in Kidney Disease
Functional and Cognitive Impairment in Advanced Kidney Disease
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:
- The range of cognitive deficits with emphasis on domains affected by vascular disease in patients with advanced CKD and those receiving hemodialysis.
- The associations between severity of cognitive impairment and severity of kidney disease.
- The prevalence of impaired IADLs and the level of health-related quality of life (HRQOL) in patients with advanced CKD and those requiring hemodialysis.
- 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.
研究概览
地位
条件
研究类型
注册 (实际的)
联系人和位置
学习地点
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New York
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The Bronx、New York、美国、10468
- James J. Peters VA Medical Center, Bronx, NY
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
取样方法
研究人群
描述
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
学习计划
研究是如何设计的?
设计细节
队列和干预
团体/队列 |
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Control
No kidney disease
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PreHD kidney disease
Kidney disease stage 4 or below
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Hemodialysis
Kidney disease receiving hemodialysis
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Neuropsychological Assessments
大体时间:1 year
|
battery of neurocognitive tests
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1 year
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合作者和调查者
调查人员
- 首席研究员:James B Post, MD、James J. Peters Veterans Affairs Medical Center
出版物和有用的链接
一般刊物
- Post JB, Jegede AB, Morin K, Spungen AM, Langhoff E, Sano M. Cognitive profile of chronic kidney disease and hemodialysis patients without dementia. Nephron Clin Pract. 2010;116(3):c247-55. doi: 10.1159/000317206. Epub 2010 Jul 2.
- Post JB, Morin KG, Handrakis JP, Rivera DR, Yen C, Sano M, Spungen AM. Cognition may be related to arterial pulsatility index in HD patients. Clin Nephrol. 2014 May;81(5):313-9. doi: 10.5414/cn107998.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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