Prevalence of Cognitive Impairment and Its Predictors Among Chronic Kidney Disease Patients: A Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Jun 3

PMID 38829896

Authors

Jialing Zhang

Leiyun Wu

Peixin Wang

Yajing Pan

Xingtong Dong

Linpei Jia

Aihua Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Cognitive impairment (CI) is common among patients with chronic kidney disease (CKD), and is associated with a poor prognosis. We assessed the prevalence and associated factors of CI in patients with CKD.

Methods: A systematic review and meta-analysis were conducted by searching PubMed, Embase, and the Web of Science through December 1, 2023. Random effects models were performed with subgroup analyses to further explore the heterogeneity.

Results: 50 studies involving 25,289 CKD patients were included. The overall prevalence of CI was 40% (95% confidence interval 33-46). The pooled prevalence of CI was relatively higher in CKD patients from Africa (58%), Asia (44%) and America (37%). Attention and executive dysfunction appeared to be the most common manifestations. The prevalence of CI was higher among patients with hemodialysis (53%) and peritoneal dialysis (39%) than those without dialysis (32%) and post-kidney transplanted (26%). In addition, advanced age, the presence of diabetes and hypertension might increase the risk of CI in CKD patients.

Conclusions: People with CKD have a high prevalence of CI, especially in patients with hemodialysis. An early and comprehensive screening for CI in CKD patients is needed to improve clinical outcomes.

Trial Registration: Registration number: PROSPERO (CRD42023412864).

Citing Articles

Association of abdominal aortic calcification with cognitive impairment in peritoneal dialysis patients.

Liu C, Shi Y, Cai J, Bai T, Li J, Yue L BMC Nephrol. 2025; 26(1):132.

PMID: 40065265 PMC: 11895183. DOI: 10.1186/s12882-025-04056-9.

Kidney function and cognitive impairment: a systematic review and meta-analysis.

Pei X, Bakerally N, Wang Z, Bo Y, Ma Y, Yong Z Ren Fail. 2025; 47(1):2463565.

PMID: 40037396 PMC: 11881663. DOI: 10.1080/0886022X.2025.2463565.

Kidney replacement therapies in the older person: challenges to decide the best option.

Selwood J, Dani M, Corbett R, Brown E Clin Kidney J. 2025; 18(2):sfaf020.

PMID: 39995809 PMC: 11848140. DOI: 10.1093/ckj/sfaf020.

References

Post J, Morin K, Sano M, Jegede A, Langhoff E, Spungen A . Increased presence of cognitive impairment in hemodialysis patients in the absence of neurological events. Am J Nephrol. 2012; 35(2):120-6. PMC: 3711004. DOI: 10.1159/000334871. View

Kurella Tamura M, Wadley V, Yaffe K, McClure L, Howard G, Go R . Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008; 52(2):227-34. PMC: 2593146. DOI: 10.1053/j.ajkd.2008.05.004. View

Cheng Z, Lin J, Qian Q . Role of Vitamin D in Cognitive Function in Chronic Kidney Disease. Nutrients. 2016; 8(5). PMC: 4882704. DOI: 10.3390/nu8050291. View

Clark W, Dehghani N, Narsimhan V, Ronco C . Uremic Toxins and their Relation to Dialysis Efficacy. Blood Purif. 2019; 48(4):299-314. DOI: 10.1159/000502331. View

Hobson P, Lewis A, Nair H, Wong S, Kumwenda M . How common are neurocognitive disorders in patients with chronic kidney disease and diabetes? Results from a cross-sectional study in a community cohort of patients in North Wales, UK. BMJ Open. 2018; 8(12):e023520. PMC: 6286490. DOI: 10.1136/bmjopen-2018-023520. View

Viana F, Boechat Y, Lugon J, Matos J . Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients. J Bras Nefrol. 2019; 41(3):375-383. PMC: 6788852. DOI: 10.1590/2175-8239-JBN-2018-0167. View

Ahn I, Kim J, Kim S, Chung J, Kim H, Kang H . Impairment of instrumental activities of daily living in patients with mild cognitive impairment. Psychiatry Investig. 2010; 6(3):180-4. PMC: 2796066. DOI: 10.4306/pi.2009.6.3.180. View

Liu G, Pi H, Hao L, Li D, Wu Y, Dong J . Vitamin D Status Is an Independent Risk Factor for Global Cognitive Impairment in Peritoneal Dialysis Patients. PLoS One. 2015; 10(12):e0143782. PMC: 4668056. DOI: 10.1371/journal.pone.0143782. View

Xu R, Pi H, Xiong Z, Liao J, Hao L, Liu G . Hyponatremia and Cognitive Impairment in Patients Treated with Peritoneal Dialysis. Clin J Am Soc Nephrol. 2015; 10(10):1806-13. PMC: 4594065. DOI: 10.2215/CJN.02240215. View

10.

Seidel U, Gronewold J, Volsek M, Todica O, Kribben A, Bruck H . Physical, cognitive and emotional factors contributing to quality of life, functional health and participation in community dwelling in chronic kidney disease. PLoS One. 2014; 9(3):e91176. PMC: 3948783. DOI: 10.1371/journal.pone.0091176. View

11.

Sarnak M, Tighiouart H, Scott T, Lou K, Sorensen E, Giang L . Frequency of and risk factors for poor cognitive performance in hemodialysis patients. Neurology. 2013; 80(5):471-80. PMC: 3590049. DOI: 10.1212/WNL.0b013e31827f0f7f. View

12.

Zachcial J, Uchmanowicz I, Czapla M, Krajewska M, Banasik M . The Association between Psychosocial and Age-Related Factors with Adherence to Immunosuppressive Therapies after Renal Transplantation. J Clin Med. 2022; 11(9). PMC: 9105664. DOI: 10.3390/jcm11092386. View

13.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

14.

Ortiz A . RICORS2040: the need for collaborative research in chronic kidney disease. Clin Kidney J. 2022; 15(3):372-387. PMC: 8862113. DOI: 10.1093/ckj/sfab170. View

15.

Harhay M, Xie D, Zhang X, Hsu C, Vittinghoff E, Go A . Cognitive Impairment in Non-Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2018; 72(4):499-508. PMC: 6153064. DOI: 10.1053/j.ajkd.2018.02.361. View

16.

Cho N, Park S, Lee E, Oh S, Oh H, Gil H . Association of Intracranial Artery Calcification with Cognitive Impairment in Hemodialysis Patients. Med Sci Monit. 2019; 25:5036-5043. PMC: 6636401. DOI: 10.12659/MSM.914658. View

17.

Kovesdy C . Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022; 12(1):7-11. PMC: 9073222. DOI: 10.1016/j.kisu.2021.11.003. View

18.

Gela Y, Getu A, Adane A, Ayal B, Akalu Y, Ambelu A . Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study. Neuropsychiatr Dis Treat. 2021; 17:1483-1492. PMC: 8139641. DOI: 10.2147/NDT.S304543. View

19.

Higgins J . Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol. 2008; 37(5):1158-60. DOI: 10.1093/ije/dyn204. View

20.

Kalantar-Zadeh K, Jafar T, Nitsch D, Neuen B, Perkovic V . Chronic kidney disease. Lancet. 2021; 398(10302):786-802. DOI: 10.1016/S0140-6736(21)00519-5. View