Pyschonephrology4
Journal Article Annotations
2021, 2nd Quarter
Pyschonephrology
Annotations by Sahil Munjal, MD
April, 2021
- Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function.
- Cognitive performance in dialysis patients -"when is the right time to test?".
PUBLICATION #1 — Pyschonephrology
Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function.
Zhuxian Zhang, Panpan He, Mengyi Liu, Chun Zhou, Chengzhang Liu, Huan Li, Yuanyuan Zhang, Qinqin Li, Ziliang Ye, Qimeng Wu, Guobao Wang, Min Liang, Xianhui Qin
Abstract: Clin J Am Soc Nephrol. 2021 Jun;16(6):889-897. doi: 10.2215/CJN.18441120. Epub 2021 May 29.
Background and objectives:
The relationship of depressive symptoms with kidney function remains poorly investigated. We aimed to evaluate the prospective association between depressive symptoms and rapid decline in kidney function in Chinese adults with normal kidney function.
Design, setting, participants, & measurements: A total of 4763 participants with eGFR≥60 ml/min per 1.73 m2 at baseline were enrolled from the China Health and Retirement Longitudinal Study. Baseline depressive symptoms were determined using a ten-item Center for Epidemiologic Studies Depression scale with a cutoff score of greater than or equal to ten to define high depressive symptoms. The GFR was estimated by a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in kidney function, defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2. Secondary outcome was defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2 and to a level of <60 ml/min per 1.73 m2 at the exit visit.
Results:
During a median follow-up of 4 years (interquartile range, 3.92-4.00), 260 (6%) participants developed rapid decline in kidney function. Overall, there was a significant positive association between baseline depressive symptoms and rapid decline in kidney function (per five-scores increment; adjusted odds ratio, 1.15; 95% confidence interval, 1.03 to 1.28) after adjustments for major demographic, clinical, or psychosocial covariates. Consistently, compared with participants with low depressive symptoms (total Center for Epidemiologic Studies Depression scale score less than ten), a significantly higher risk of rapid decline in kidney function was found among those with high depressive symptoms (total Center for Epidemiologic Studies Depression scale score greater than or equal to ten; adjusted odds ratio, 1.39; 95% confidence interval, 1.03 to 1.88). Similar results were found for the secondary outcome (per five-scores increment; adjusted odds ratio, 1.26; 95% confidence interval, 1.06 to 1.51).
Conclusions:
High depressive symptoms were significantly associated with a higher risk of rapid kidney function decline among Chinese adults with normal kidney function.
Annotation
The finding:
High depressive symptoms (CES- D≥10) were associated with a 39% increased risk of rapid kidney function decline among a population of patients with normal kidney function in China. Depressive symptoms were assessed with the Center for Epidemiology Studies Depression (CES-D) scale with a median follow-up of four years. Four specific depressive symptoms (bothered by things, had trouble concentrating, felt everything was an effort, and felt lonely) were significantly associated with rapid kidney function decline (defined as an annualized decline in eGFR of at least 5 mL/min/1.73m2).
Strength and weaknesses:
Data were taken from a nationally representative, longitudinal study with measurements of both serum creatinine and cystatin C (more accurate representation of GFR levels). All participants were assessed by one-to-one interviews with a structured questionnaire.
The risk of residual confounding could not be fully excluded. Kidney function was not assessed during interim follow-up visits. Urine protein or albumin data were not available, as was information about psychiatric diagnosis at baseline. Study population had high depressive symptoms which may be moderated by different psychosocial factors, so the findings may be of limited generalizability.
Relevance:
Chronic kidney disease (CKD) is a leading risk factor for cardiovascular disease, kidney failure, and mortality, and depressive symptoms are a risk factor for CKD. The relationship may be explained by several biological factors including inflammatory cytokines, impairment in immune function, health literacy, and unhealthy lifestyle choices. The study highlights the importance of depressive symptom screening and effective interventions to improve primary prevention of CKD.
Type of study (EBM guide):
Cohort study
PUBLICATION #2 — Pyschonephrology
Cognitive performance in dialysis patients -"when is the right time to test?".
Hristos Karakizlis, Stefanie Thiele, Brandon Greene, Joachim Hoyer
Abstract: BMC Nephrol. 2021 Jun 2;22(1):205. doi: 10.1186/s12882-021-02333-x.
Background:
Cognitive impairment in chronic kidney disease, especially in end stage renal disease, is a public health problem. Nevertheless, the cause of chronic kidney disease still remains unclear. A prevalence of cognitive impairment in patients with end stage renal disease of up to 87% has been found.
Methods:
The study at hand deals with the research on the - potential - effect of timing on cognitive performance when testing cognitive impairment in hemodialysis patients during the dialysis cycle. We tested cognitive performance with a neuropsychological test battery (RBANS, Repeatable Battery for the Assessment of Neuropsychological Status) on two occasions while patients were on dialysis as well as on a dialysis-free day. In addition, all participants were rated using the Geriatric Depression Scale (GDS) and several demographic and clinical variables were recorded in order to investigate their possible influence on cognitive performance. The patients were recruited in three dialysis centers in the central region of Hesse, Germany. Twenty-six participants completed the 3 testings during a period of 6 weeks. The testing was carried out in the dialysis centers.
Results:
Looking at the total scale score, patients achieved the best cognitive performance in the RBANS during the first 2 h on dialysis with 81.1 points. When comparing the scores of the three measurement occasions (first 2 h, Timepoint 1 vs. last 2 h, Timepoint 2 vs. dialysis free day, Timepoint 3, however, no significant difference in the total scale score was detected. But patients showed significantly better cognitive performance in language in the first 2 h (p < 0.001) as well as in the last 2 h (p < 0.001) compared with the dialysis-free day.
Conclusion:
Due to the high prevalence of cognitive impairment, there is an increasing need to assess cognitive function in dialysis patients. Our data show that the time point of testing (first 2 h on hemodialysis vs. last 2 h on hemodialysis vs. Hemodialysis free day) had no influence of cognitive function in hemodialysis patients in routine indications.
Annotation
The finding:
Cognitive impairment is almost universal among patients with chronic kidney disease. However, it is unclear when to time cognitive testing for patients receiving dialysis. The study showed no measurable differences in cognitive performance (RBANS, Repeatable Battery for the Assessment of Neuropsychological Status) among ESRD patients during dialysis cycle (first 2 h, last 2 h) and a day after.
Strength and weaknesses:
This was a prospective randomized study with a high completion rate. The extensive neurocognitive test battery used is more sensitive than screening tests and has been validated for showing an absence of learning effects when retesting. Limitations include a small sample size(n=26), slightly younger patient sample (65y), overrepresentation of male subjects (73%), and possible selection bias. The study was conducted in Germany which may limit generalizability.
Relevance:
Previous studies have shown a high prevalence of cognitive impairment in patients with ESRD (51-87%), emphasizing the need for increased assessment. There are a multitude of factors that cause cognitive impairment in this population including older age, worsening kidney function, uraemia, cerebrovascular disease, depression, and intradialytic hypotension. These findings contrast with previous studies that suggest patients demonstrate their best cognitive performance after dialysis. Given the importance of cognitive skills to understand and follow health-related information, larger studies are needed to ascertain how cognition varies with respect to timing of dialysis.
Type of study (EBM guide):
Cohort study
