A VAN ZWIETEN1,2, G WONG1,2,3, M RUOSPO4,5, S PALMER6, A TEIXEIRA-PINTO1,2, M BARULLI7, A IURILLO7, V SAGLIMBENE1,4, P NATALE4,8, L GARGANO4, M MURGO4, C LOY1,9, R TORTELLI7, J CRAIG1,2,10, D JOHNSON11,12, M TONELLI13, J HEGBRANT4, C WOLLHEIM4, G LOGROSCINO7,14, G STRIPPOLI1,4,8
1Sydney School of Public Health, University of Sydney, Sydney, Australia, 2Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, Australia, 3Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 4Diaverum Medical-Scientific Office, Lund, Sweden, 5Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy, 6Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand, 7Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari “A. Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy, 8Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari, Italy, 9Huntington Disease Service, Westmead Hospital, Westmead, Australia, 10Department of Nephrology, Children’s Hospital at Westmead, Westmead, Australia, 11Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia, 12Translational Research Institute, University of Queensland, Woolloongabba, Australia, 13Cumming School of Medicine, University of Calgary, Calgary, Canada, 14Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “A. Moro”, Bari, Italy
Aim: To determine the association between cognitive function and all-cause mortality in adults on haemodialysis, and the independent and interactive effects of educational level.
Background: Cognitive impairment is common in dialysis patients, and is associated with lower levels of education. Associations of cognitive impairment and education with mortality in dialysis populations are understudied.
Methods: We recruited adult haemodialysis patients from 20 centres in Italy, assessing their cognitive function across 5 domains (memory, attention, executive function, language, perceptual-motor function) with a neuropsychological battery of 10 tests, and their self-reported educational level. Associations of cognition and education with all-cause mortality were examined in multivariable Cox regression models.
Results: Of 958 patients in the network, 676 participated (70.6%). Patients’ median age was 70.9 years (IQR: 59.9-78.1) and 262 (38.8%) were female. Educational levels were 338 (50.0%) primary or less, 163 (24.1%) lower secondary, 175 (25.9%) upper secondary or higher. Of 664 with data, 527 (79.4%) were impaired on at least 1 cognitive domain. Median follow-up was 3.29 years (IQR: 1.90-3.58) and there were 206 deaths over 1874.22 person-years. Adjusted HR (95% CI) for mortality on cognition were: 1.77 (1.07-2.93) for any impairment (compared to none, N=630); 1.48 (0.82-2.68) for 1 domain impaired, 1.88 (1.01-3.53) for 2 domains, 2.01 (1.14-3.55) for 3 or more (compared to none, N=564); and 0.68 (0.51-0.92) per standard deviation increase in global cognitive score from principal components analysis (N=429). Adjusted HR (95% CI) for education were 0.94 (0.61-1.45) for lower secondary and 1.49 (1.02-2.18) for upper secondary or higher (relative to primary/less, N=630). The cognition-by-education interaction was not significant (p=.691).
Conclusions: Cognitive impairment appears to be a risk factor for mortality in haemodialysis patients.
Anita is a PhD Candidate at the University of Sydney School of Public Health and Centre for Kidney Research with a background in psychology and public health. She is interested in the dynamic interactions between education, economic disadvantage and health across the life-course with a specific focus on kidney disease.