MO691: Risk Factors Associated with Cognitive Dysfunction in Peritoneal Dialysis
Notice bibliographique
Résumé
Abstract BACKGROUND AND AIMS Cognitive dysfunction (CD) in peritoneal dialysis (PD) patients has been increasingly described as a risk factor for worse outcomes such as peritonitis, technique failure and mortality. Identification of these patients and associated risk factors is of most importance to mitigate these consequences. In this study our aims were: (i) to determine the presence of CD in a population of PD patients and (ii) to identify possible risk factors associated with CD. METHOD We performed an observational, cross-sectional study to evaluate cognitive function using the Montreal cognitive assessment (MOCA) test and mini mental state (MMS) test in 56 PD patients at our program whenever they were present in a schedule PD appointment. Patients with diagnosis of dementia or severe neurological impairment, active cancer or active infection were excluded. Demographic variables, comorbidities, peritonitis and exit-site infections episodes, laboratory data and dialysis adequacy were retrospectively collected in a 3-month period. RESULTS We evaluated 56 patients with a median age of 65 years (IQR 25.5); 53.6% were male. About 73.2% of our patients had a lower level of education; 64.3% were not professionally active; 16.1% lived alone and 25.0% needed help to perform PD treatment. Charlson comorbidity index (CCI) median score was 5 (IQR 2). Most prevalent comorbidities were hypertension (85.7%), cardiovascular disease (37.5%), diabetes (37.5%) and peripheral arterial disease (PAD) (21.4%). PD therapy median duration was 20 months (IQR 24). Automated PD was the most common modality (60.7%). Episodes of peritonitis and exit-site infection were detected in 10.7% and 3.6% of patients, respectively. CD assessed by MOCA test was present in 64.3% of patients, with a median score of 21.5 (IQR 5.5). Visuospatial/executive, naming, attention, language, abstraction and delayed recall areas were impaired in this population (P < 0.05). Possible predictors of CD with MOCA test (Mann–Whitney or Qui square) were: higher age (P = 0.0001); lower level of education (P = 0.003); not professionally active (P = 0.004); need of a helper (P = 0.014); continuous ambulatory PD modality (P = 0.004). Higher CCI score (P = 0.0003), cardiovascular disease (P = 0.061) and PAD (P = 0.024) were also associated with CD. Lower levels of urea (P = 0.022) and Kt/V (P = 0.031) and higher levels of bicarbonate (P = 0.040), all related to CD. Multivariable analysis showed that lower Kt/V was the most relevant factor related to CD (P = 0.006). CD assessed by MMS test was present in 33.9% of patients, with a median score of 23 (IQR 5). Impairment of all areas evaluated were observed namely orientation, immediate and delayed recall, attention and calculation, language and visuospatial (P < 0.05). Again, predictors of CD were higher age (P = 0.044); very low level of education (P = 0.024); need of a helper (P = 0.004). Higher CCI score (P = 0.001), diabetes (P = 0.018) and PAD (P = 0.012) were also associated with CD. Multivariate analysis showed that higher CCI score was the most relevant factor related to CD (P = 0.02). CONCLUSION CD in our PD population was present in 64.3% of patients with MOCA test and 33.9% of patients with MMS test, with similar results to those described in the current literature. Patients with CD had impairment of multiple areas of cognition, such as visuospatial, memory, attention and language. Higher age, lower level of education, and need of a helper were risk factors identified for CD. Patients with CD also have a higher load of vascular diseases. Patients with lower Kt/V levels presented more CD detected by MOCA test, which can be associated with a lower clearance of possible toxins that contribute to CD; however, larger studies have to be done to confirm this hypothesis.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».