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Abstract: SA-PO738

Associations of Cognitive Function and Education Level with All-Cause Mortality in Adults on Hemodialysis: The COGNITIVE-HD Cohort Study

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • van Zwieten, Anita, University of Sydney, Sydney, New South Wales, Australia
  • Wong, Germaine, University of Sydney, Sydney, New South Wales, Australia
  • Ruospo, Marinella, Diaverum Medical Scientific Office, Lund, Sweden
  • Teixeira-Pinto, Armando, University of Sydney, Sydney, New South Wales, Australia
  • Loy, Clement, University of Sydney, Sydney, New South Wales, Australia
  • Craig, Jonathan C., University of Sydney, Sydney, New South Wales, Australia
  • Strippoli, Giovanni F.M., Diaverum Medical Scientific Office, Lund, Sweden

Group or Team Name

  • The COGNITIVE-HD Study Investigators

Cognitive impairment is common in dialysis patients and is associated with lower education levels. Associations of cognitive impairment and education with mortality in dialysis patients are understudied. We aimed to assess the association between cognitive function and all-cause mortality in adults on hemodialysis, and the independent and interactive effects of education.


We recruited adult hemodialysis patients from 20 centers in Italy, assessing their cognitive function on 5 domains (memory, attention, executive function, language, perceptual-motor function) with 10 neuropsychological tests, and their self-reported education. We examined associations of cognition (any domain impaired, number of domains impaired, global score from principal components analysis of all tests) and education with all-cause mortality in multivariable Cox models.


Of 958 patients, 676 participated (70.6%). Patients’ median age was 70.9 years (IQR: 59.9-78.1) and 262 (38.8%) were female. Education levels were 338 (50.0%) primary/less, 163 (24.1%) lower secondary, 175 (25.9%) upper secondary/higher. Of 664 with data, 527 (79.4%) were impaired on at least 1 domain. Median follow-up was 3.3 years (IQR: 1.9-3.6) and there were 206 deaths in 1874.2 person-years. Adjusted HR (95% CI) for cognition were: 1.77 (1.07-2.93) for any impairment (referent: none, N=630); 1.48 (0.82-2.68) for 1 domain impaired, 1.88 (1.01-3.53) for 2 domains, 2.01 (1.14-3.55) for 3 or more (referent: none, N=564); 0.68 (0.51-0.92) per standard deviation increase in global cognitive score (N=429). Adjusted education HR (95% CI) were 0.94 (0.61-1.45) for lower secondary and 1.49 (1.02-2.18) for upper secondary/higher (referent: primary/less, N=630). The cognition-by-education interaction was not significant (p=.691).


Cognitive impairment appears to predict mortality in hemodialysis patients.


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