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Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients
Drew DA, Weiner DE, Tighiouart H, Duncan S, Gupta A, Scott T, Sarnak MJ.. American journal of kidney diseases : the official journal of the National Kidney Foundation, 2017-01-26
Topic: Risk, prevention and care in population studies
Background Cognitive impairment is common in patients treated with hemodialysis. The trajectory of cognitive function and risk factors for cognitive decline remain uncertain in this population. Study design Longitudinal cohort. Setting & participants 314 prevalent hemodialysis patients. Predictors Age, sex, race, education level, hemodialysis vintage, cause of end-stage renal disease, and baseline history of cardiovascular disease. Outcomes Cognitive function as determined by a comprehensive neurocognitive battery, administered at baseline and yearly when possible. Individual cognitive test results were reduced into 2 domain scores using principal components analysis, representing memory and executive function, which were used as our coprimary outcomes and by definition have a mean of zero and SD of 1. Results Mean age was 63 years; 54% were men, 22% were black, and 90% had at least a high school education. During a median follow-up of 2.1 (IQR, 0.9-4.2) years, 196 had at least 1 follow-up test, 156 died, and 43 received a kidney transplant. Linear mixed models and joint models, which accounted for competing risks from death, dropout, or kidney transplantation, showed nearly identical results. The joint model demonstrated a decline in executive function (-0.09 [95% CI, -0.13 to -0.05] SD per year), whereas memory improved slightly (0.05 [95% CI, 0.02 to 0.08] SD per year). A significant yearly decline was also seen in the Mini-Mental State Examination score (median change, -0.41; 95% CI, -0.57 to -0.25). Older age was the only significant risk factor for steeper executive function decline (-0.04 [95% CI, -0.06 to -0.02] SD steeper annual decline for each 10 years of age). Limitations Prevalent hemodialysis patients only, limited follow-up testing due to high mortality rate, and exclusion of participants with severe cognitive deficits or dementia. Conclusions Prevalent hemodialysis patients demonstrate significant cognitive decline, particularly within tests of executive function. Older age was the only statistically significant risk factor for steeper cognitive decline, which may have important clinical consequences for patient management and education. Future studies should evaluate strategies to maintain or improve cognitive function.
Key findings
- Individual cognitive test results were reduced into 2 domain scores using principal components analysis, representing memory and executive function, which were used as our coprimary outcomes and by definition have a mean of zero and SD of 1.
- Results Mean age was 63 years; 54% were men, 22% were black, and 90% had at least a high school education.
- Linear mixed models and joint models, which accounted for competing risks from death, dropout, or kidney transplantation, showed nearly identical results.
- The joint model demonstrated a decline in executive function (-0.09 [95% CI, -0.13 to -0.05] SD per year), whereas memory improved slightly (0.05 [95% CI, 0.02 to 0.08] SD per year).
- A significant yearly decline was also seen in the Mini-Mental State Examination score (median change, -0.41; 95% CI, -0.57 to -0.25).
Why it matters
In 314 hemodialysis patients followed over time, executive function declined while memory slightly improved. This describes cognitive trajectories in people on hemodialysis and does not test any treatment, cure, or prevention for Alzheimer's disease.
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Study details
- Study designlongitudinal study
- Evidence strengthModerate
How this study scored 56/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (American journal of kidney diseases : the official journal of the National Kidney Foundation) |
| Journal's citation record | 3 / 4 | American Journal of Kidney Diseases: journal h-index 293 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 119 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 10.8 citations a year over 11 year(s) since 2017 |
| Impact for its field and year | 3 / 6 | Cited 7.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 2 / 4 | Cited 34 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Mark J. Sarnak: h-index 115 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Tufts University: institution h-index 1,045 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 28131531) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 56 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Drew, D. A., Weiner, D. E., Tighiouart, H., Duncan, S., Gupta, A., Scott, T., et al. (2017). Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients. American journal of kidney diseases : the official journal of the National Kidney Foundation. https://doi.org/10.1053/j.ajkd.2016.11.015
Vancouver
Drew DA, Weiner DE, Tighiouart H, Duncan S, Gupta A, Scott T, et al. Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2017. doi:10.1053/j.ajkd.2016.11.015. PMID: 28131531.
BibTeX
@article{drew2017-28131531,
author = {Drew, D. A. and Weiner, D. E. and Tighiouart, H. and Duncan, S. and Gupta, A. and Scott, T. and Sarnak, M. J.},
title = {{Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients}},
journal = {American journal of kidney diseases : the official journal of the National Kidney Foundation},
year = {2017},
doi = {10.1053/j.ajkd.2016.11.015},
pmid = {28131531},
url = {https://doi.org/10.1053/j.ajkd.2016.11.015}
}
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