Alexiuk Jamie, Harasemiw Oksana, Vanderlinden Jessica, Verrelli Davide, Tarca Brett, Collister David, Ribeiro Heitor, Corradetti Bonnie, Fowler Kevin, Manfredini Fabio, McAdams-DeMarco Mara, Chu Nadia, Jesudason Shilpa, McKeaveney Clare, Leon Silvia J, Anandh Urmila, Tollitt James, Thompson Stephanie, Dasgupta Indranil, Bohm Clara
Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.
Kidney360. 2025 May 1;6(5):739-753. doi: 10.34067/KID.0000000708. Epub 2025 Jan 24.
Cognitive impairment is prevalent in CKD, affecting quality of life, self-management, and decision-making. It worsens with disease progression. This Delphi study engaged diverse stakeholders to identify 27 critical research questions on cognitive impairment in CKD for future focus. Top priorities include preventing cognitive decline, preserving cognition, routine monitoring, and adjusting dialysis treatment to reduce cognitive impairment.
Cognition is a research priority for people living with CKD, but identification of critical research questions is lacking. This study aimed to determine which cognition-related research questions are most important to CKD stakeholders.
A modified Delphi technique with three survey rounds was used. The study sample included three panels () recruited through international patient and kidney research networks, kidney societies, and snowball sampling with email invitations. Survey rounds were distributed electronically through Research Electronic Data Capture. In round 1 (October 2021–May 2022), respondents contributed three important research questions regarding cognition in CKD (free text). After deduplication and qualitative synthesis, respondents ranked the importance of these questions on a nine-point Likert scale in round 2 (February–April 2023). Questions with mean and median ratings of >7 by at least two respondent panels or rated critically important by the lived experience panel were reranked in round 3 (August–September 2023) and assessed for consensus to identify the final list of priority research questions.
Respondents (=152) identified 125 and 44 discrete questions after rounds 1 and 2, respectively. The final shortlist included 27 questions in eight categories. The most critical research question identified was “What factors cognitive impairment in people receiving dialysis?” Overall, respondents prioritized questions focusing on prevention and treatment of cognitive impairment. Scores between the panels were significantly different for 16 questions. Those with lived CKD experience prioritized quality of life, researchers emphasized developing interventions to mitigate cognitive impairment, and clinicians prioritized the effect of CKD treatment on cognitive impairment.
Through an established consensus methodology involving key stakeholder groups, we identified 27 critical research questions about cognition in CKD. These questions should guide future study design and outcome selection.
认知障碍在慢性肾脏病（CKD）中普遍存在，会影响生活质量、自我管理和决策。它会随着疾病进展而恶化。这项德尔菲研究让不同的利益相关者参与进来，以确定27个关于CKD认知障碍的关键研究问题，作为未来的重点。首要任务包括预防认知能力下降、保持认知、进行常规监测以及调整透析治疗以减少认知障碍。
认知是CKD患者的一个研究重点，但缺乏对关键研究问题的识别。本研究旨在确定哪些与认知相关的研究问题对CKD利益相关者最为重要。
采用经过改进的三轮德尔菲技术。研究样本包括通过国际患者和肾脏研究网络、肾脏学会以及通过电子邮件邀请进行滚雪球抽样招募的三个小组。调查轮次通过研究电子数据采集系统以电子方式分发。在第1轮（2021年10月至2022年5月），受访者提出了三个关于CKD认知的重要研究问题（自由文本）。在进行重复数据删除和定性综合后，受访者在第2轮（2023年2月至4月）根据九点李克特量表对这些问题的重要性进行了排序。至少有两个受访者小组的平均评分和中位数评分>7或生活经验小组评为极其重要的问题在第3轮（2023年8月至9月）重新排序，并评估是否达成共识，以确定优先研究问题的最终清单。
受访者（n = 152）在第1轮和第2轮后分别确定了125个和44个不同的问题。最终入围名单包括八个类别的27个问题。确定的最关键研究问题是“哪些因素导致接受透析的患者出现认知障碍？”总体而言，受访者优先考虑关注认知障碍预防和治疗的问题。16个问题在各小组之间的得分存在显著差异。有CKD生活经历的人优先考虑生活质量，研究人员强调开发减轻认知障碍的干预措施，而临床医生则优先考虑CKD治疗对认知障碍的影响。
通过一种涉及关键利益相关者群体的既定共识方法，我们确定了27个关于CKD认知的关键研究问题。这些问题应指导未来的研究设计和结果选择。
