Background. Cognitive impairment with its negative effect on quality of life has been reported in chronic kidney disease (CKD). The paucity of the literature on cognitive impairment in Africans with CKD prompted this study. Objectives. To determine the frequency and pattern of cognitive impairment in patients with stages 3 to 5 CKD. Methods. We studied 79 consecutive consenting adults with a National Kidney Foundation (NKF) stage 3 to 5 CKD based on their estimated glomerular filtration rate using the Cockcroft-Gault formula. The controls consisted of healthy demographically matched subjects. Community screening instrument for dementia (CSI’D), trail making test A (TMTA), and trail making test B (TMTB) were used for cognitive assessment. Results. More CKD patients had cognitive impairment compared with controls using CSI’D (51.9% versus 2.5%, ); TMTA (53.2% versus 0%, ); and TMTB (40% versus 0%, ). The odds of having cognitive impairment increased in the presence of CKD when assessed using CSI’D (OR？=？2.026; CI？=？1.607–2.555); TMTA (OR？=？3.13; CI？=？2.40–4.09) and TMTB (OR？=？3.22; CI？=？2.42–4.25). CKD patients performed poorer on tests of executive function TMTA ( ) and TMTB ( ) while CSI’D showed significantly lower scores on multiple cognitive domains. Conclusions. Significant cognitive impairment in multiple domains exists among Nigerians with CKD. 1. Introduction Chronic kidney disease (CKD) is a growing public health problem [1–4] with evidence pointing to an increasing incidence and prevalence worldwide [5, 6]. However, it is grossly underdiagnosed in Nigeria and other developing countries. The hospital frequency in Nigeria ranges between 1.6 and 8% of hospital admissions [7]. Although CKD affects all races equally, end-stage renal disease (ESRD) is four times more prevalent in blacks than whites in the United States [1]. CKD is found in persons of all ages, but higher incidence rates occur in patients at or above 65 years of age [8–10], an age range that is traditionally associated with a high prevalence of cognitive impairment. However, a lower average age has been reported among Nigerians with CKD [7]. Although data on prevalence and pattern of cognitive impairment among Nigerians with CKD is scanty, in other climes a high incidence of cognitive impairment has been reported among patients with CKD [1, 11–13]. Murray et al. [14] observed in their study of 338 haemodialysis patients that 37.0% had severe cognitive impairment which was more than three times the 5–10% estimated prevalence of dementia in the US population-based studies. Sehgal et al.
References
[1]
M. Madero, A. Gul, and M. J. Sarnak, “Cognitive function in chronic kidney disease,” Seminars in Dialysis, vol. 21, no. 1, pp. 29–37, 2008.
[2]
A. S. Levey, R. Atkins, J. Coresh et al., “Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from Kidney Disease Improving Global Outcomes,” Kidney International, vol. 72, no. 3, pp. 247–259, 2007.
[3]
C. O. Alebiosu and O. E. Ayodele, “The global burden of chronic kidney disease and the way forward,” Ethnicity and Disease, vol. 15, no. 3, pp. 418–423, 2005.
[4]
M. O. Afolabi, E. A. Abioye-Kuteyi, F. A. Arogundade, and I. S. Bello, “Prevalence of chronic kidney disease in a Nigerian family practice population,” South African Family Practice, vol. 51, no. 2, pp. 132–137, 2009.
[5]
“NKF, K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification,” American Journal of Kidney Diseases, vol. 39, pp. S17–S31, 2002.
[6]
S. R. Orth and S. I. Hallan, “Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients—absence of evidence or evidence of absence?” Clinical Journal of the American Society of Nephrology, vol. 3, no. 1, pp. 226–236, 2008.
[7]
W. Akinsola, W. O. Odesanmi, J. O. Ogunniyi, and G. O. A. Ladipo, “Diseases causing chronic renal failure in Nigerians—a prospective study of 100 cases,” African Journal of Medicine and Medical Sciences, vol. 18, no. 2, pp. 131–137, 1989.
[8]
M. Kurella, G. M. Chertow, J. Luan, and K. Yaffe, “Cognitive impairment in chronic kidney disease,” Journal of the American Geriatrics Society, vol. 52, no. 11, pp. 1863–1869, 2004.
[9]
E. A. Brown, “Should older patients be offered peritoneal dialysis?” Peritoneal Dialysis International, vol. 28, no. 5, pp. 444–448, 2008.
[10]
M. Heras, M. J. Fernández-Reyes, and R. Sánchez, “Outcome implications of chronic kidney disease in the elderly,” Nefrologia, vol. 30, no. 2, pp. 151–157, 2010.
[11]
A. O. Ogunrin, E. I. Unuigbe, and C. Azubuike, “Memory and perceptuo-motor performance in Nigerians with chronic renal impairment,” Medical Science Monitor, vol. 12, no. 12, pp. CR535–CR539, 2006.
[12]
P. Madan, O. P. Kalra, S. Agarwal, and O. P. Tandon, “Cognitive impairment in chronic kidney disease,” Nephrology Dialysis Transplantation, vol. 22, no. 2, pp. 440–444, 2007.
[13]
M. Kurella, G. M. Chertow, J. Luan, and K. Yaffe, “Cognitive impairment in chronic kidney disease,” Journal of the American Geriatrics Society, vol. 52, no. 11, pp. 1863–1869, 2004.
[14]
A. M. Murray, D. E. Tupper, D. S. Knopman et al., “Cognitive impairment in hemodialysis patients is common,” Neurology, vol. 67, no. 2, pp. 216–223, 2006.
[15]
A. R. Sehgal, S. F. Grey, P. B. DeOreo, and P. J. Whitehouse, “Prevalence, recognition, and implications of mental impairment among hemodialysis patients,” American Journal of Kidney Diseases, vol. 30, no. 1, pp. 41–49, 1997.
[16]
T. J. Grabowski, S. W. Anderson, and G. E. Cooper, “Neural substrate of cognition,” Continuum: Lifelong Learning Neurol, vol. 8, no. 2, pp. 7–40, 2002.
[17]
S. Gauthier, B. Reisberg, M. Zaudig et al., “Mild cognitive impairment,” The Lancet, vol. 367, no. 9518, pp. 1262–1270, 2006.
[18]
M. K. Tamura and K. Yaffe, “Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies,” Kidney International, vol. 79, no. 1, pp. 14–22, 2011.
[19]
A. M. Murray and D. S. Knopman, “Cognitive impairment in CKD: no longer an occult burden,” American Journal of Kidney Diseases, vol. 56, no. 4, pp. 615–618, 2010.
[20]
M. Kurella, D. L. Mapes, F. K. Port, and G. M. Chertow, “Correlates and outcomes of dementia among dialysis patients: the dialysis outcomes and practice patterns study,” Nephrology Dialysis Transplantation, vol. 21, no. 9, pp. 2543–2548, 2006.
[21]
J. Gussekloo, R. G. J. Westendorp, E. J. Remarque, A. M. Lagaay, T. J. Heeren, and D. L. Knook, “Impact of mild cognitive impairment on survival in very elderly people: cohort study,” British Medical Journal, vol. 315, no. 7115, pp. 1053–1054, 1997.
[22]
C. Melloni, E. D. Peterson, A. Y. Chen et al., “Cockcroft-Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes,” Journal of the American College of Cardiology, vol. 51, no. 10, pp. 991–996, 2008.
[23]
J. L. Teruel Briones, J. Sabater, C. Galeano et al., “The Cockcroft-Gault equation is better than MDRD equation to estimate the glomerular filtration rate in patients with advanced chronic renal failure,” Nefrologia, vol. 27, no. 3, pp. 313–319, 2007.
[24]
H. C. Hendrie, A. Ogunniyi, K. S. Hall et al., “Incidence of Dementia and Alzheimer disease in 2 communities: yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana,” Journal of the American Medical Association, vol. 285, no. 6, pp. 739–747, 2001.
[25]
B. N. Jones, E. L. Teng, M. F. Folstein, and K. S. Harrison, “A new bedside test of cognition for patients with HIV infection,” Annals of Internal Medicine, vol. 119, no. 10, pp. 1001–1004, 1993.
[26]
J. D. Corrigan and N. S. Hinkeldey, “Relationships between parts A and B of the Trail Making Test,” Journal of Clinical Psychology, vol. 43, no. 4, pp. 402–409, 1987.
[27]
R. D. Oliveira-Souza, J. Moll, L. J. Passman, et al., “Trail marking and cognitive-shifting,” Arquivos de Neuro-Psiquiatria, vol. 58, no. 3, pp. 826–829, 2000.
[28]
J. C. Stivelman, “Benefits of anaemia treatment on cognitive function,” Nephrology Dialysis Transplantation, vol. 15, supplement 3, pp. 29–35, 2000.
[29]
Y. Slinin, M. L. Paudel, A. Ishani et al., “Kidney function and cognitive performance and decline in older men,” Journal of the American Geriatrics Society, vol. 56, no. 11, pp. 2082–2088, 2008.
[30]
E. A. Gaudino, M. W. Geisler, and N. K. Squires, “Construct validity in the trail making test: what makes Part B harder?” Journal of Clinical and Experimental Neuropsychology, vol. 17, no. 4, pp. 529–535, 1995.
[31]
E. Uniegbe, O. Ogunrin, and R. Onyemekeihia, “Neurocognitive performances in Nigerian Africans with chronic renal failure,” Nigerian Journal of Health and Biomedical Sciences, vol. 3, no. 2, pp. 108–111, 2004.
[32]
A. O. Ogunrin, E. I. Unuigbe, and C. Azubuike, “Memory and perceptuo-motor performance in Nigerians with chronic renal impairment,” Medical Science Monitor, vol. 12, no. 12, pp. CR535–CR539, 2006.
[33]
A. M. Murray, “Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden,” Advances in Chronic Kidney Disease, vol. 15, no. 2, pp. 123–132, 2008.
[34]
S. M. Hailpern, M. L. Melamed, H. W. Cohen, and T. H. Hostetter, “Moderate chronic kidney disease and cognitive function in adults 20 to 59 years of age: third National Health and Nutrition Examination Survey (NHANES III),” Journal of the American Society of Nephrology, vol. 18, no. 7, pp. 2205–2213, 2007.
[35]
S. V. Jassal, J. Roscoe, D. LeBlanc, G. M. Devins, and S. Rourke, “Differential impairment of psychomotor efficiency and processing speed in patients with chronic kidney disease,” International Urology and Nephrology, vol. 40, no. 3, pp. 849–854, 2008.
[36]
S. Gelb, R. J. Shapiro, A. Hill, and W. L. Thornton, “Cognitive outcome following kidney transplantation,” Nephrology Dialysis Transplantation, vol. 23, no. 3, pp. 1032–1038, 2008.
