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Kidney function and cognitive decline in frail elderly: two faces of the same coin?

  • Nephrology - Original Paper
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Abstract

Background and aims

Cognitive and renal impairment are pervasive among elderly frails, a high-risk, geriatric sub-population with peculiar clinical characteristics. In a series of frail individuals with non-advanced chronic kidney disease (CKD), we aimed at assessing the entity of functional, general health and cognitive impairment and the possible relationship between these types of dysfunction and the severity of renal impairment.

Methods

2229 geriatric subjects were screened for frailty and CKD. Severity of CKD was assessed by eGFR (CKD-EPI formula). Frailty was established by the Fried Index. Functional, general health and cognitive status were assessed by validated score measures.

Results

Final analysis included 271 frail CKD subjects (162 women, 109 men). Mean eGFR was 64.25 ± 25.04 mL/min/1.73 m2. Prevalence of mild-to-moderate CKD (stage 3–4) was 44%. Twenty-six percent of patients had severe cognitive impairment, while mild and moderate impairment was found in 7 and 67% of individuals, respectively. All subjects had poor functional and general health status. Cognitive capacities significantly decreased across CKD stages (p for trend < 0.0001). In fully adjusted multivariate analyses, cognitive status remained an independent predictor of eGFR (β = 0.465; p < 0.0001).

Conclusions

Mild-to-moderate CKD is highly pervasive among frail elderly individuals and the severity of renal dysfunction is independently correlated with that of cognitive impairment. Future studies are advocated to clarify whether the combination of kidney and mental dysfunction may portend a higher risk of worsen outcomes in this high-risk population.

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Authors and Affiliations

  1. Nephrology and Dialysis Unit, “Pugliese-Ciaccio” General Hospital, Via Michele Torcia, 4, 88100, Catanzaro, Italy

    Giuseppe Coppolino

  2. Institute of Clinical Physiology, CNR - Italian National Council of Research, Reggio Calabria, Italy

    Davide Bolignano

  3. Geriatric Unit, “Pugliese-Ciaccio” General Hospital, Catanzaro, Italy

    Giovanni Ruotolo

  4. Renal Unit, Department of Health Sciences, “Magna Graecia” University, Catanzaro, Italy

    Michele Andreucci

  5. Center for Cognitive Disorders and Dementia, Azienda Sanitaria Provinciale di Catanzaro, Catanzaro, Italy

    Pietro Gareri, Carmen Ruberto, Maurizio Rocca & Alberto Castagna

Authors
  1. Giuseppe Coppolino
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  2. Davide Bolignano
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  3. Pietro Gareri
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  4. Carmen Ruberto
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  5. Michele Andreucci
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  6. Giovanni Ruotolo
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  7. Maurizio Rocca
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  8. Alberto Castagna
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Corresponding author

Correspondence to Giuseppe Coppolino.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Coppolino, G., Bolignano, D., Gareri, P. et al. Kidney function and cognitive decline in frail elderly: two faces of the same coin?. Int Urol Nephrol 50, 1505–1510 (2018). https://doi.org/10.1007/s11255-018-1900-3

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  • DOI: https://doi.org/10.1007/s11255-018-1900-3

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