Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia.
Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia.
Am J Kidney Dis. 2019 Oct;74(4):452-462. doi: 10.1053/j.ajkd.2019.03.424. Epub 2019 Jun 1.
RATIONALE & OBJECTIVE: In the general population, cognitive impairment is associated with increased mortality, and higher levels of education are associated with lower risks for cognitive impairment and mortality. These associations are not well studied in patients receiving long-term hemodialysis and were the focus of the current investigation.
Prospective cohort study.
SETTING & PARTICIPANTS: Adult hemodialysis patients treated in 20 Italian dialysis clinics.
Patients' cognitive function across 5 domains (memory, attention, executive function, language, and perceptual-motor function), measured using a neuropsychological assessment comprising 10 tests; and patients' self-reported years of education.
All-cause mortality.
Nested multivariable Cox regression models were used to examine associations of cognition (any domain impaired, number of domains impaired, and global function score from principal components analysis of unadjusted test scores) and education with mortality and whether there were interactions between them.
676 (70.6%) patients participated, with a median age of 70.9 years and including 38.8% women. Cognitive impairment was present in 79.4% (527/664; 95% CI, 76.3%-82.5%). During a median follow-up of 3.3 years (1,874 person-years), 206 deaths occurred. Compared to no cognitive impairment, adjusted HRs for mortality were 1.77 (95% CI, 1.07-2.93) for any impairment, 1.48 (95% CI, 0.82-2.68) for 1 domain impaired, 1.88 (95% CI, 1.01-3.53) for 2 domains, and 2.01 (95% CI, 1.14-3.55) for 3 to 5 domains. The adjusted HR was 0.68 (95% CI, 0.51-0.92) per standard deviation increase in global cognitive function score. Compared with primary or lower education, adjusted HRs were 0.79 (95% CI, 0.53-1.20) for lower secondary and 1.13 (95% CI, 0.80-1.59) for upper secondary or higher. The cognition-by-education interaction was not significant (P=0.7).
Potential selection bias from nonparticipation and missing data; no data for cognitive decline; associations with education were not adjusted for other socioeconomic factors.
Cognitive impairment is associated with premature mortality in hemodialysis patients. Education does not appear to be associated with mortality.
在一般人群中，认知障碍与死亡率增加有关，而较高的教育水平与认知障碍和死亡率降低有关。这些关联在接受长期血液透析的患者中尚未得到很好的研究，这也是当前研究的重点。
前瞻性队列研究。
在意大利 20 家透析诊所接受治疗的成年血液透析患者。
患者的认知功能，涉及 5 个领域（记忆、注意力、执行功能、语言和感知运动功能），使用包括 10 项测试的神经心理学评估进行测量；以及患者的自我报告受教育年限。
全因死亡率。
使用嵌套多变量 Cox 回归模型来检验认知功能（任何领域受损、多个领域受损和未经调整测试分数的主成分分析的总体功能评分）和教育与死亡率之间的关联，以及它们之间是否存在交互作用。
676（70.6%）名患者参与了研究，中位年龄为 70.9 岁，其中 38.8%为女性。认知障碍的存在率为 79.4%（527/664；95%CI，76.3%-82.5%）。在中位随访 3.3 年（1874 人年）期间，发生了 206 例死亡。与无认知障碍相比，调整后的死亡率 HR 分别为：1.77（95%CI，1.07-2.93）为任何受损，1.48（95%CI，0.82-2.68）为 1 个领域受损，1.88（95%CI，1.01-3.53）为 2 个领域受损，以及 2.01（95%CI，1.14-3.55）为 3 至 5 个领域受损。总体认知功能评分每增加一个标准差，调整后的 HR 为 0.68（95%CI，0.51-0.92）。与小学或以下教育相比，接受中等或以下教育和高等教育的调整后 HR 分别为 0.79（95%CI，0.53-1.20）和 1.13（95%CI，0.80-1.59）。认知功能与教育之间的交互作用不显著（P=0.7）。
非参与和数据缺失可能导致选择偏倚；没有认知衰退的数据；与教育相关的关联未调整其他社会经济因素。
认知障碍与血液透析患者的过早死亡有关。教育似乎与死亡率无关。
