Cognitive Impairment in Kidney Disease
Condition: Kidney Insufficiency, Chronic
MeSH terms: Kidney Diseases; Renal Insufficiency; Renal Insufficiency, Chronic; Cognitive Dysfunction
Study type: Observational

Summary: 
      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.
    


Observational model: Case-Crossover
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Veterans at the Bronx VA Renal Clinic, Hemodialysis Unit, and Primary Care Clinic
      
Biospecimen description: 
      Serum obtained and kept until end of study.