Wang Kevin, Echeagaray Andrea Razcόn, Campbell Sandra M, Bohm Clara, Tennankore Karthik, Thompson Stephanie, Bello Aminu K, Pannu Neesh, Bathini Lavanya, McIsaac Mark, Klarenbach Scott, Collister David
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada.
Kidney Med. 2025 May 29;7(8):101037. doi: 10.1016/j.xkme.2025.101037. eCollection 2025 Aug.
RATIONALE & OBJECTIVE: Mild cognitive impairment (MCI) and dementia disproportionately affect people with chronic kidney disease (CKD) and kidney failure. Screening instruments can accurately identify cognitive impairment in the general population, but their performance in the setting of kidney disease is unclear. We aimed to summarize the performance of screening instruments for cognitive impairment in adults with CKD or kidney failure.
Systematic review and meta-analysis.
SETTING & STUDY POPULATIONS: Adults with CKD or kidney failure (dialysis or kidney transplantation).
Studies published in Medline, EMBASE, CINAHL, Cochrane Library, and PsycINFO through October 2022, evaluating the diagnostic performance of cognitive screening instruments compared to a neuropsychological battery gold standard.
Study characteristics including population, screening instrument, gold standard, operating characteristics including sensitivity, specificity, odds ratio, and optimal cutoffs were extracted by 2 investigators. Conflicts were resolved through discussion with another reviewer.
Random-effects models estimated pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve. Risk of bias was assessed using the QUality Assessment instrument for Diagnostic Accuracy Studies-2.
We included 10 studies involving >1,800 participants with CKD or kidney failure. The most frequently evaluated screening instruments were the Montreal Cognitive Assessment (MoCA) and the Mini-Mental Status Examination. For MCI/dementia, the MoCA had the best diagnostic performance using a cutoff of 24, with a pooled sensitivity and specificity of 0.94 (95% confidence interval [CI], 0.81-0.98) and 0.63 (95% CI, 0.35-0.85), respectively. Without any specific cutoff, the Mini-Mental Status Examination had a pooled sensitivity of 0.48 (95% CI, 0.28-0.69) and pooled specificity of 0.95 (95% CI, 0.78-0.99).
Small number of studies, absence of kidney transplantation and hemodiafiltration populations, selective reporting of operating characteristics for optimal cutoffs, and high degree of statistical heterogeneity.
Although further research is needed to evaluate the operating characteristics of MCI/dementia screening instruments in CKD, dialysis, and kidney transplantation, based on the current evidence, we recommend using the MoCA with a threshold of 24.
轻度认知障碍（MCI）和痴呆对慢性肾脏病（CKD）和肾衰竭患者的影响尤为严重。筛查工具能够准确识别普通人群中的认知障碍，但其在肾脏病患者中的表现尚不清楚。我们旨在总结用于筛查CKD或肾衰竭成年患者认知障碍的工具的性能。
系统评价与荟萃分析。
患有CKD或肾衰竭（透析或肾移植）的成年人。
截至2022年10月在Medline、EMBASE、CINAHL、Cochrane图书馆和PsycINFO上发表的研究，评估认知筛查工具与神经心理成套测验金标准相比的诊断性能。
两名研究人员提取研究特征，包括人群、筛查工具、金标准，以及包括敏感性、特异性、比值比和最佳临界值在内的操作特征。通过与另一位审阅者讨论解决冲突。
随机效应模型估计合并敏感性、特异性、诊断比值比和受试者工作特征曲线下面积。使用诊断准确性研究质量评估工具-2评估偏倚风险。
我们纳入了10项研究，涉及1800多名患有CKD或肾衰竭的参与者。评估最频繁的筛查工具是蒙特利尔认知评估量表（MoCA）和简易精神状态检查表。对于MCI/痴呆，MoCA采用24分的临界值时诊断性能最佳，合并敏感性和特异性分别为0.94（95%置信区间[CI]，0.81-0.98）和0.63（95%CI，0.35-0.85）。在没有任何特定临界值的情况下，简易精神状态检查表的合并敏感性为0.48（95%CI，0.28-0.69），合并特异性为0.95（95%CI，0.78-0.99）。
研究数量少，缺乏肾移植和血液透析滤过人群，选择性报告最佳临界值的操作特征，以及高度的统计异质性。
尽管需要进一步研究来评估MCI/痴呆筛查工具在CKD、透析和肾移植中的操作特征，但基于目前的证据，我们建议使用临界值为24分的MoCA。
