Kidney Week

Abstract: FR-PO774

Pre-Dialysis Cognitive Impairment and Pre-Emptive Placement of Dialysis Access: Findings from the Chronic Renal Insufficiency Cohort Study

Session Information

• Hemodialysis: Vascular Access - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 603 Hemodialysis: Vascular Access

Authors

• Harhay, Meera Nair, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States

Meera Nair Harhay,

• Xie, Dawei, University of Pennsylvania School of Medicine Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania, United States

Dawei Xie,

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu,

• Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States

Alan S. Go,

• Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States

Jing Chen,

• Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

James P. Lash,

• Akkina, Sanjeev, Loyola University Medical Center, Chicago, Illinois, United States

Sanjeev Akkina,

• Zhang, Xiaoming, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania, United States

Xiaoming Zhang,

• Vittinghoff, Eric, University of California, San Francisco, San Francisco, California, United States

Eric Vittinghoff,

• Sozio, Stephen M., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Stephen M. Sozio,

• Seliger, Stephen L., University of Maryland School of Medicine, Baltimore, Maryland, United States

Stephen L. Seliger,

• Dobre, Mirela A., Case Western Reserve University, Cleveland, Ohio, United States

Mirela A. Dobre,

• Blumenthal, Jacob B, Department of Veterans Affairs, Baltimore, Maryland, United States

Jacob B Blumenthal,

• Deo, Rajat, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Rajat Deo,

• Reese, Peter P., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Peter P. Reese,

• Yaffe, Kristine, UCSF, San Francisco, California, United States

Kristine Yaffe,

• Kurella Tamura, Manjula, Stanford University, Palo Alto, California, United States

Manjula Kurella Tamura,

Group or Team Name

• CRIC Study Investigators

Background

Cognitive impairment (CI) is a common finding in late-stage chronic kidney disease (CKD), but few studies have examined its direct impacts on dialysis preparedness. We assessed the independent association of pre-dialysis CI on the probability of pre-emptive permanent access placement among participants from the Chronic Renal Insufficiency Cohort (CRIC) Study who started dialysis.

Methods

We identified 630 CRIC participants who initiated dialysis. We defined pre-dialysis CI as a Modified Mini-Mental State Examination score < 80 measured prior to dialysis initiation. We estimated the association between CI and access placement using logistic regression models for the probability of 1) having permanent access placed before dialysis initiation, and 2) using the permanent access at the first dialysis session.

Results

The cohort had a mean age of 59 years (SD 12 years) and mean eGFR of 16 ml/min/1.73m² (SD 3 ml/min) at the pre-dialysis cognitive assessment. Pre-dialysis CI was present in 14% (n=89) of the cohort. Compared to participants without CI, more participants with CI reported low income status (64% vs 38%, p<0.001) and low educational attainment (71% vs 22%, p<0.001). Pre-emptive access was placed in 75% of the cohort (n=473), and 45% of participants initiated dialysis using a permanent access (n=279). After adjustment for eGFR slope, demographics, diabetes, hypertension, vascular disease, functional status, and smoking, pre-dialysis CI was associated with a 48% lower probability of pre-emptive access placement (aOR 0.52, 95% CI 0.29-0.91) and a 45% lower probability of starting dialysis using a permanent access (aOR 0.55, 95% CI 0.32-0.97). After adjustment for socioeconomic variables including income, these associations were no longer statistically significant.

Conclusion

In this study, we found an association between pre-dialysis CI and suboptimal access outcomes, though this finding was not independent of socioeconomic status. Given the known relationship between socioeconomic status and CI, future studies may consider incorporating measures of pre-dialysis CI when evaluating strategies to reduce disparities in dialysis preparedness.

Funding

• NIDDK Support