Cognitive impairment and patient reported outcomes in advanced kidney disease
Bibliographic record
Abstract
Shared decision making is now an integral part of renal practice. Quality of life is therefore an important consideration, especially for older patients. This thesis provides insight into the influence of dialysis modality on quality of life in older people with advanced kidney disease. It also explores the relationship between cognitive impairment and dialysis. Firstly, quality of life measures were compared between older patients on assisted peritoneal dialysis and haemodialysis. Patients on assisted peritoneal dialysis were matched to haemodialysis patients by baseline characteristics. Quality of life assessments were carried out quarterly for 2 years. Following multivariate analyses, there was no consistent difference in quality of life between patients on haemodialysis and assisted peritoneal dialysis. The second study assesses the influence of dialysis on cognition and patient reported outcome measures in patients with advanced kidney disease. Patients on haemodialysis, peritoneal dialysis or with chronic kidney disease (eGFR < 30ml/min) patients were recruited. Study participants were assessed 4 monthly for up to 2 years. Mixed model analysis showed that cognitive function declined faster in dialysis patients compared with non-dialysis patients with chronic kidney disease. In the dialysis cohort, executive function was better preserved in patients on peritoneal dialysis compared with haemodialysis patients. Dialysis did not consistently influence trends in patient reported outcome measures during follow up. Finally, the relationship between cognition and decision making capacity was explored in a small pilot of renal patients. Cognition and decision making capacity were assessed by the Montreal Cognitive Assessment and Macarthur Competence Assessment tools respectively. Patients with lower cognitive scores tended to have lower capacity assessment scores, albeit without reaching statistical significance. In older patients with advanced kidney disease, risk factors other than dialysis modality, influence quality of life. Cognitive decline, one such risk factor, may accelerate with dialysis depending on modality. It may also affect decision making. These findings highlight the need to screen for geriatric syndromes in older patients with renal disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".