Self-Care Peritoneal Dialysis Patients with Cognitive Impairment Have a Higher Risk of Peritonitis in the Second Year

Abstract

Introduction: Cognitive impairment is common among patients on peritoneal dialysis (PD). We hypothesize that cognitive impairment has a negative impact on the outcome of patients on PD, especially with regard to peritonitis.

Methods: This was a single-center 2-year prospective cohort study involving 206 patients at 1 PD unit. Cognitive impairment was defined by the latest Hong Kong Montreal Cognitive Assessment Score (HK-MoCA) multiple cut-offs as determined by age and years of education. Eighty percent of patients had come back for interval HK-MoCA. The HK-MoCA was performed at baseline and after 1 year on PD. Potential risk factors for cognitive impairment and peritonitis were studied separately for the first and second year.

Results: For cognitive impairment at baseline, multivariate analyses showed that age (odds ratio [OR] 1.003, 95% confidence interval [CI] 1.003 – 1.065, p = 0.03), female sex (OR 3.57, 95% CI 1.60 – 7.97, p = 0.002), peripheral vascular disease (PVD) (OR 3.46, 95% CI 1.33 – 9.01, p = 0.01), and hemoglobin level (OR 0.60, 95% CI 0.43 – 0.84, p = 0.003) were statistically significant factors. For cognitive impairment at 1 year, multivariate analyses showed that age (OR 1.07, 95% CI 1.02 – 1.012, p = 0.007), female sex (OR 5.87, 95% CI 1.86 – 18.5, p = 0.003), and PVD (OR 3.68, 95% CI 1.07 – 12.84, p = 0.04) were statistically significant independent factors for cognitive impairment at 1 year.