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Cited by 270Dialysis and Renal Disease ManagementDementia and Cognitive Impairment ResearchCancer-related cognitive impairment studies

Cognition in people with end-stage kidney disease treated with hemodialysis: a systematic review and meta-analysis.

O’Lone, Emma, Connors, Michael, Masson, Philip, Wu, Sunny, Kelly, Patrick J., Gillespie, David, Parker, Daniel, Whiteley, William +4 more·2016·American Journal of Kidney Diseases
DOI 10.1053/j.ajkd.2015.12.028
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Abstract

Background Cognitive impairment is associated with poorer quality of life, risk for hospitalization, and mortality. Cognitive impairment is common in people with end-stage kidney disease treated with hemodialysis, yet the severity and specific cognitive deficits are uncertain.Study design Systematic review and meta-analysis.Setting & population Adults receiving hemodialysis compared with the general population, people with non-dialysis-dependent chronic kidney disease (NDD-CKD), people receiving peritoneal dialysis, or people with nondialyzed chronic kidney failure.Selection criteria for studies Randomized controlled trials, cohort or cross-sectional studies without language restriction.Index tests Validated neuropsychological tests of cognition.Outcomes Cognitive test scores, aggregated by cognitive domain: orientation and attention, perception, memory, language, construction and motor performance, concept formation and reasoning, and executive functions.Results 42 studies of 3,522 participants. Studies were of high or uncertain risk of bias, assessed by the Newcastle-Ottawa Scale. People treated with hemodialysis had worse cognition than the general population, particularly in attention (n=22; standardized mean difference [SMD], -0.93; 95% CI, -1.18 to -0.68). Hemodialysis patients performed better than nondialyzed patients with chronic kidney failure in attention (n=6; SMD, 0.70; 95% CI, 0.45 to 0.96) and memory (n=6; SMD, 0.36; 95% CI, 0.08 to 0.63), but had poorer memory than the general population (n=16; SMD, -0.41; 95% CI, -0.91 to 0.09) and people with NDD-CKD (n=5; SMD, -0.40; 95% CI, -0.60 to -0.21). There were insufficient data to show other differences among people receiving hemodialysis and those receiving peritoneal dialysis or with NDD-CKD.Limitations Potentially biased studies, not wholly adjusted for education. High heterogeneity, mainly due to the large variety of tests used to assess cognition.Conclusions People treated with hemodialysis have impaired cognitive function compared to the general population, particularly in the domains of orientation and attention and executive function. Cognitive deficits in specific domains should be further explored in this population and should be considered when approaching education and chronic disease management.

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Authors
O’Lone, E., Connors, M., Masson, P., Wu, S., Kelly, P. J., Gillespie, D., Parker, D., Whiteley, W., Strippoli, G. F. M., Palmer, S. C., Craig, J. C., & Webster, A. C.
Affiliations
  • The University of Sydney (AU)
  • University of Edinburgh (GB)
  • Desert AIDS Project (US)
  • University of Otago (NZ)
Corresponding author
O’Lone, Emma
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
2016-06
Volume
67
Issue
6
Pages
925-935
ISSN
0272-6386 (ISSN-L)
DOI
10.1053/j.ajkd.2015.12.028
OpenAlex
W2282280448
Cited by
266
References
77
Citations by year
2026: 22 · 2025: 17 · 2024: 33 · 2023: 36 · 2022: 40 · 2021: 27 · 2020: 29 · 2019: 16 · 2018: 23 · 2017: 15 · 2016: 7
FWCI
2.57
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
Funders
Royal Society
Topics
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
cognitive impairment, end-stage renal disease, hemodialysis, attention, memory, executive function, neuropsychological assessment, chronic kidney disease, peritoneal dialysis, language and perception, motor performance, quality of life, hospitalization risk, mortality risk, risk of bias
MeSH terms
Cognition Disorders, Cross-Sectional Studies, Renal Dialysis, Humans, Kidney Failure, Chronic

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