Di Rosa Mirko, D'Alia Sonia, Guarasci Francesco, Soraci Luca, Pierpaoli Elisa, Lenci Federica, Ricci Maddalena, Onder Graziano, Volpato Stefano, Ruggiero Carmelinda, Cherubini Antonio, Corsonello Andrea, Lattanzio Fabrizia
Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy.
Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy.
J Clin Med. 2020 Jul 12;9(7):2202. doi: 10.3390/jcm9072202.
The prognostic interaction between chronic kidney disease (CKD) and cognitive impairment is still to be elucidated. We investigated the potential interaction of overall cognitive impairment or defective constructional praxis and CKD in predicting 1-year mortality among 646 older patients discharged from hospital. The estimated glomerular filtration rate (eGFR) was calculated using the Berlin Initiative Study (BIS) equation. Cognitive impairment was assessed by the Mini Mental State Exam (MMSE) and defective constructional praxis was ascertained by the inherent MMSE item. The study outcome was 1-year mortality. Statistical analysis was carried out using Cox regression. After adjusting for potential confounders, the co-occurrence of eGFR <30 and overall cognitive impairment (Hazard Ratio (HR) = 3.12, 95% Confidence Interval (CI) = 1.26-7.77) and defective constructional praxis (HR = 2.50, 95% CI = 1.08-5.77) were associated with the outcome. No significant prognostic interaction of eGFR < 30 with either overall cognitive impairment (HR = 1.99, 95% CI = 0.38-10.3) or constructional apraxia (HR = 1.68, 95% CI = 0.33-8.50) was detectable, while only cognitive deficits were found significantly associated with the outcome in the interaction models (HR = 3.12, 95% CI = 1.45-6.71 for overall cognitive impairment and HR = 2.16, 95% CI = 1.05-4.45 for constructional apraxia). Overall cognitive impairment and defective constructional praxis may be associated with increased risk of 1-year mortality among older hospitalized patients with severe CKD. However, no significant prognostic interaction between CKD and cognitive impairment could be observed.
慢性肾脏病（CKD）与认知障碍之间的预后相互作用仍有待阐明。我们调查了646名出院老年患者中，整体认知障碍或结构性运用障碍与CKD在预测1年死亡率方面的潜在相互作用。采用柏林倡议研究（BIS）方程计算估算肾小球滤过率（eGFR）。通过简易精神状态检查表（MMSE）评估认知障碍，并通过MMSE固有项目确定结构性运用障碍。研究结局为1年死亡率。使用Cox回归进行统计分析。在对潜在混杂因素进行校正后，eGFR<30与整体认知障碍（风险比（HR）=3.12，95%置信区间（CI）=1.26 - 7.77）以及结构性运用障碍（HR = 2.50，95%CI = 1.08 - 5.77）的共存与结局相关。未检测到eGFR<30与整体认知障碍（HR = 1.99，95%CI = 0.38 - 10.3）或结构性失用症（HR = 1.68，95%CI = 0.33 - 8.50）之间存在显著的预后相互作用，而在相互作用模型中仅发现认知缺陷与结局显著相关（整体认知障碍的HR = 3.12，95%CI = 1.45 - 6.71；结构性失用症的HR = 2.16，95%CI = 1.05 - 4.45）。整体认知障碍和结构性运用障碍可能与重度CKD老年住院患者1年死亡风险增加相关。然而，未观察到CKD与认知障碍之间存在显著的预后相互作用。
