Title: Study of Cognitive Status in Patients with Chronic Kidney Disease: A Cross Sectional Study
Authors: Dr Kumar S, Dr Sai Arun Reddy P, Dr Katta Subraya Prakash Rao
Background: There appears to be a pandemic of chronic kidney disease gripping the world, the full spectrum of which ranges from asymptomatic state to obvious kidney failure. The last decade has seen significant increase in the incidence, prevalence, and complications of CKD mostly because of the development of wider definitions for CKD by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. There is ever growing interest in finding out the prevalence of cognitive impairment in patients with CKD which appears to be increasing not only because of increased incidence of CKD but also from increased survival of patients having CKD. Cognitive impairment is associated with an increased risk of death, which is mostly due to cerebro-vascular disease and prevalence of traditional and non-traditional vascular risk factors in chronic kidney disease (CKD). It is important to identify cognitive dysfunction in patients with CKD and take appropriate steps so as to improve outcome in such patients.
Methods: This was a cross-sectional, observational, questionnaire based study conducted in the department of General medicine of a tertiary care medical college situated in a semi-urban area. Cases were included in our study on the basis of a predefined criteria. Using a data collection form demographic details such as Age, Sex, Education, Occupation and socio-economic status of the patients were noted. Presence of systemic illnesses such as diabetes or hypertension and their duration was also noted down. Investigations such as complete blood count and renal function tests were noted in all the cases. Mini mental state examination (MMSE) & Montreal Cognitive Assessment Questionnaire (MoCA) was used to assess cognitive status. Patients were divided into 5 groups depending on stage of chronic kidney disease. Estimated glomerular filtration rate was calculated using modification of diet in renal disease equation. For statistical purposes p value less than 0.05 was taken as significant. SSPE 16 software was used for statistical analysis.
Results: Out of 50 studied cases there were 28 (56%) males and 22 (44%) females with an M: F ratio of 1:0.78. The most common affected age group was 41-50 years (28%) followed by 51-60 year (24%). In majority of the patients (78%) blood urea was found to be between 50-150 mg/dl whereas in 24 (48%) patients sr creatinine was between 3.0-6.0 mg/dl. Stage 5 and stage 4 renal disease was seen in 22 (44%) and 20 (40%) patients respectively. Most common etiological causes of CKD were found to be diabetes mellitus (38%) and a combination of diabetes and hypertension (28%). Mild cognitive impairment was seen in 27 (54%) patients and most common age group to be affected was found to be between 61-70 years (18%). Though males were more commonly affected by cognitive impairment the difference was not statistically significant (P=0.77). Similarly there was no statistically significant difference in cognitive impairment of patients with various stages of CKD (p=0.44). Patients with higher age group were found to be more likely to be affected by cognitive impairment (0.0001). MoCA was found to be a superior scale to detect mild cognitive impairment associated with chronic kidney disease patients.
Conclusion: The study concluded that CKD is one of the important diseases seen among the common people. Hypertension and Diabetes are the common causes of this disease. Cognitive impairment was found to be more common in males and patients with stage 4 and stage 5 CKD but the difference was found to statistically insignificant (P>0.05).
Keywords: Chronic kidney disease, Risk Factors, Montreal Cognitive Assessment Questionnaire, Cognitive Impairment.