Demenz bei terminaler Niereninsuffizienz, eine Pilotstudie zur Untersuchung der Häufigkeit und relevanter Risikofaktoren bei 158 Patienten des PHV Dialysezentrums Gießen

Chronische Niereninsuffizienz und terminales, dialysepflichtiges Nierenversagen (ESRD) sind bekannte, unabhängige Risikofaktoren für die Entwicklung kognitiver Defizite und einer Demenz. Die Inzidenz des Diabetes mellitus und der Arteriellen Hypertonie, als die häufigsten Ursachen für chronische Nie...

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Bibliographic Details
Main Author: Klein, Christoph
Contributors: Kuhlmann, Uwe (PD Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2016
Online Access:PDF Full Text
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Table of Contents: Chronic kidney injury and end stage renal disease (ESRD) are known as independent risk factors for early cognitive decline and dementia. The incidence of diabetes mellitus and arterial hypertension as today’s main causes for kidney injury and ESRD in industrialized nations, is increasing since years - and both are themselves risk factors for cognitive impairment. Recent data revealed prevalence rates of 3% for dementia in German dialysis patients, when ICD-10 and medical history records were retrospectively analyzed. International studies resolve surprisingly high rates of cognitive impairment in ESRD. National data, elucidating that problem, had not been obtainable. Therefore we screened a well defined small but representative cohort of 223 dialysis patients in a single center pilot study (PHV Giessen). After detailed information, 158 patients met the inclusion criteria and gave written consent. As screening instruments we administered the Mini Mental Status Examination (MMSE) and the Geriatric Depression Scale (GDS) within the 158 dialysis patients. We additionally inquired personal and medical history, pharmacotherapy, laboratory results, blood pressure and dialysis efficiency to identify possible risk factors. If MMSE cut off results of ≤ 24 points were considered, the pilot study could identify 35 in 158 patients (22%) being suspicious for at least moderate cognitive impairment. These patients were significantly more often of female gender (p=0.02), at higher age (p<0.0001), lower education (p<0.0001) and showed more frequent strokes or transient ischemic attacks (p=0.0016). Subjects additionally revealed higher serum-aluminum levels (p=0.029). Unexpectedly, tobacco consumption (p=0.016) was significantly lower. The GDS showed no significant difference to those with MMSE results ≥ 25 points (p=0.28). With these findings we could show evidence for relevant rates of at least moderate cognitive impairment in a national dialysis unit and we confirmed some of the known risk factors for cognitive impairment in ESRD. Future analysis is needed by performing a regional prevalence analysis with intensive neurocognitive testing to confirm the presented MMSE screening, detect more specific cognitive domain deficits, as well as patients with mild neurocognitive disorder and gain detailed epidemiologic information.