Frailty and Cognitive Function in Incident Hemodialysis Patients

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2015 Nov 18

PMID 26573615

Citations 99

Authors

Mara A McAdams-DeMarco

Jingwen Tan

Megan L Salter

Alden Gross

Lucy A Meoni

Bernard G Jaar

Wen-Hong Linda Kao

Rulan S Parekh

Dorry L Segev

Stephen M Sozio

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD.

Design, Setting, Participants, & Measurements: At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models.

Results: At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: -2.4 points; 95% confidence interval [95% CI], -4.2 to -0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P<0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P<0.001) and with worse 3MS at 1-year follow-up (-2.8 points; 95% CI, -5.4 to -0.2; P=0.03).

Conclusions: In adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).

Citing Articles

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Yang T, Kang Y, Kim D, Kim Y, Kwon O, Lee T BMC Nephrol. 2025; 26(1):65.

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Abnormal neurovascular coupling exists in patients with peritoneal dialysis and hemodialysis: evidence from a multi-mode MRI study.

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Cognitive frailty in maintenance hemodialysis: a scoping review.

Zhang K, Wei S, Wang R, Li A, Zhang N, Ni C Int Urol Nephrol. 2025; .

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