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Frailty and Cognitive Function in Incident Hemodialysis Patients
McAdams-DeMarco MA, Tan J, Salter ML, Gross A, Meoni LA, Jaar BG, Kao WH, Parekh RS et al.. Clinical journal of the American Society of Nephrology : CJASN, 2015-11-16
Topic: Risk, prevention and care in population studies
Background and objectives Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD. Design, setting, participants, & measurements At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models. Results At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: -2.4 points; 95% confidence interval [95% CI], -4.2 to -0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P Conclusions In adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).
Key findings
- Frailty has been associated with poor cognitive function in older adults without kidney disease.
- We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD.
- Results At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black.
- Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: -2.4 points; 95% confidence interval [95% CI], -4.2 to -0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P<0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P<0.001) and with worse 3MS at 1-year follow-up (-2.8 points; 95% CI, -5.4 to -0.2; P=0.03).
Why it matters
This study found that frailty was independently associated with lower cognitive function at cohort entry in adults undergoing hemodialysis. It suggests that frailty may be a marker for poor cognitive function in this population.
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Study details
- Study designcohort study
- Participants324
- Effect size56.5%; 72.8%; 34.0%
- Evidence strengthModerate
How this study scored 61/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Clinical journal of the American Society of Nephrology : CJASN) |
| Journal's citation record | 2 / 4 | Clinical Journal of the American Society of Nephrology: journal h-index 234 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following 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 | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 324 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 198 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 15.2 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 4 / 6 | Cited 9.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 2 / 4 | Cited 47 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Stephen M. Sozio: h-index 39 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26573615) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 61 / 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's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
McAdams-DeMarco, M. A., Tan, J., Salter, M. L., Gross, A., Meoni, L. A., Jaar, B. G., et al. (2015). Frailty and Cognitive Function in Incident Hemodialysis Patients. Clinical journal of the American Society of Nephrology : CJASN. https://doi.org/10.2215/cjn.01960215
Vancouver
McAdams-DeMarco MA, Tan J, Salter ML, Gross A, Meoni LA, Jaar BG, et al. Frailty and Cognitive Function in Incident Hemodialysis Patients. Clinical journal of the American Society of Nephrology : CJASN. 2015. doi:10.2215/cjn.01960215. PMID: 26573615.
BibTeX
@article{mcadamsdemarco2015-26573615,
author = {McAdams-DeMarco, M. A. and Tan, J. and Salter, M. L. and Gross, A. and Meoni, L. A. and Jaar, B. G. and Kao, W. H. and Parekh, R. S. and others},
title = {{Frailty and Cognitive Function in Incident Hemodialysis Patients}},
journal = {Clinical journal of the American Society of Nephrology : CJASN},
year = {2015},
doi = {10.2215/cjn.01960215},
pmid = {26573615},
url = {https://doi.org/10.2215/cjn.01960215}
}
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