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Abstract: SA-PO291

Cognitive and Physical Functioning in Relation to Survival in Patients on Chronic Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ekart, Robert, Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
  • Bevc, Sebastjan, Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
  • Piko, Nejc, Univerzitetni Klinicni Center Maribor, Maribor, Maribor, Slovenia
  • Petreski, Tadej, Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
  • Varda, Luka, Univerzitetni Klinicni Center Maribor, Maribor, Maribor, Slovenia
  • Hojs, Radovan, Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
Background

Little is known about the relationship between cognitive and physical function and survival of patients on chronic hemodialysis (HD).
The Mini-Mental State Examination (MMSE) is an instrument that can help quickly diagnose whether a person has mild cognitive impairment by answering questions in several cognitive domains.
The Barthel Index (BI) is an ordinal scale that measures performance in activities of daily living (ADL).
The aim of the present study was to determine whether the MMSE and the BI score are predictors of mortality in patients on chronic HD.

Methods

Eighty-eight patients (mean age: 63.7±13.1 years, 61.4% male) on chronic HD (dialysis vintage 62±64 months) were studied cross-sectionally and longitudinally. Their cognitive function was assessed with the MMSE and physical function with the BI questionnaire at baseline. The MMSE and BI were performed during a midweek HD session, avoiding the beginning and end of each treatment. A MMSE score ≤23 was considered to indicate cognitive impairment, and a BI score ≤15 was considered to indicate physical impairment. Demographic, clinical, and laboratory parameters were recorded for each patient.

Results

The mean (SD) MMSE score was 24.7±4.5, and the mean BI score was 19.2±2.5. Patients with a MMSE score ≤23 had a higher dialysis vintage (82.6 vs. 52.4 months; p=0.039), patients with a BI score ≤15 had lower serum albumin (39 vs. 35 g/L; p=0.031). After a mean follow-up of 1334±640 days (range: 21-2149 days), 47 (53.4%) patients died and 3 were transplanted. None of the patients were lost or transferred to another department. The deceased patients were statistically significantly older (p<0.001), had lower serum albumin (p=0.025) and lower BI score (p=0.036). Kaplan-Meier analysis showed that survival was significantly lower in patients with a BI score ≤15 (log rank x2:13.15; p<0.001). We found no difference in survival with a MMSE score regardless of the MMSE score. According to the adjusted Cox regression analysis, mortality was associated with higher age (HR 1.06, 95% CI: 1.03-1.09, p<0.001) and inversely associated with BI score (HR 0.86, 95% CI 0.78-0.94, p=0.001).

Conclusion

The BI score is associated with an increased risk of death in HD patients and it should be routinely assessed to predict survival of HD patients.