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Abstract: FR-PO431

Association of Cognitive Impairment with Subsequent Cardiovascular Disease (CVD) Hospitalization: A Prospective ESKD Cohort Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Park, Jenny Rose, Oregon Health & Science University, Portland, Oregon, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Fitzpatrick, Jessica, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
  • Parekh, Rulan S., Women's College Hospital, Toronto, Ontario, Canada
  • Monroy-Trujillo, Jose Manuel, Johns Hopkins University, Baltimore, Maryland, United States
  • Sozio, Stephen M., Johns Hopkins University, Baltimore, Maryland, United States
Background

Cognitive impairment (CI) and stroke are common among patients with ESKD receiving hemodialysis. Whether worsened CI can be a clinical indicator of increased risk of stroke and other cardiovascular disease (CVD) events in patients with ESKD is unknown.

Methods

Participants were incident hemodialysis patients from a prospective cohort study, the PACE Study. To assess CI, we used validated tests, the Multiple Mini-Mental State Exam (3MS) and Trail Making Test (TMT) Parts A and B. We used Cox proportional-hazards regression models to evaluate the association of CI at baseline with incident CVD events, adjusting for demographic characteristics, education, depression, and hypercholesterolemia.

Results

Among 568 participants, the average age was 56.3 years (SD: 13.5 years; range: 20-90 years), and most participants are black (n=393; 69.2%) or white (n=161, 28.3%). Over a median follow-up of 2.9 years, 120 (21%) CVD hospitalizations occurred among the 568 participants. Worse TMT-A scores, indicating more severe CI, were associated with subsequent CVD hospitalization on unadjusted analysis (HR=1.08; 95% CI: 1.02-1.06). Similarly, those classified as cognitively “deficient” were at higher risk for subsequent CVD hospitalization, even after further adjustments for a history of diabetes, smoking, prevalent stroke, and atrial fibrillation (HR=1.53; 95% CI: 1.13-2.08). On interaction analysis, the TMT-A scores of patients without diabetes (HR=1.38; 95% CI: 1.02-1.87) were associated with future CVD events. The 3MS test and TMT-B results did not show an association between CI and future CVD hospitalization.

Conclusion

In this study, patients with ESKD new to hemodialysis with worse TMT-A scores were more likely to have future CVD hospitalizations. Further studies should gauge whether this practical bedside test case helps predict a patient’s cardiovascular risk.

Funding

  • NIDDK Support