ABSTRACT
BACKGROUND: Cognitive impairment is common among hemodialysis (HD) patients and is associated with poor treatment compliance and mortality. The aim of this study is to evaluate relatively young HD patients with less comorbidities using the Montreal Cognitive Assessment (MoCA) and identify clues for earlier detection of cognitive impairment with the help of cognitive subscale scores. MATERIALS AND METHODS: A total of 103 chronic HD patients (mean age 48.3 years) and 37 stage-3 to 5 chronic kidney disease (CKD) patients with similar demographics were included. Patients with cerebrovascular disease, dementia, depression, malignancy, and infections were excluded. All participants were tested with MoCA. Patients with an MoCA global score < 24/30 were considered cognitively impaired. Groups were compared for MoCA subscales and clinical features. RESULTS: 75 patients (72.8%) in the HD group and 19 in the CKD group (51.3%) had impaired cognition. The number of patients with cognitive impairment was significantly higher in the HD group compared with the CKD group (p = 0.024). The mean total MoCA score was lower in the HD group (p = 0.043). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain was significantly lower in the HD group (p = 0.001). CONCLUSION: In this study, we showed that cognitive impairment was more common in HD patients compared with predialytic CKD patients. This difference was predominantly related to the difference in executive scores. We may think that young HD patients with less comorbidities are also at risk for cognitive impairment. Noticing progressive declines in MoCA cognitive domains, before the development of global cognitive impairment, could be beneficial for HD patients.â©.
Subject(s)
Cognitive Dysfunction , Renal Dialysis , Renal Insufficiency, Chronic , Cognitive Dysfunction/complications , Cognitive Dysfunction/epidemiology , Cohort Studies , Humans , Mental Status and Dementia Tests , Middle Aged , Renal Dialysis/adverse effects , Renal Dialysis/statistics & numerical data , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapyABSTRACT
PURPOSE: Chronic kidney disease (CKD) is an inflammatory process. In addition to increased morbidity and mortality, inflammation also contributes to the progression of CKD. Neutrophil/lymphocyte ratio (NLR) is a marker of inflammation. Some recent data suggest that NLR may predict the progression of CKD. METHODS: In this study, 5-year data of 740 patients with stage 2-4 CKD were reviewed retrospectively. Demographic data, NLR, CRP, albumin, the amount of proteinuria were recorded. At the beginning and the end of follow-up the glomerular filtration rate (GFR) and the annual GFR decline rate were calculated. Patients were divided to high and low NLR group according to median value of their baseline NLR. Reaching stage 5 CKD or initiation of renal replacement therapy was determined as end-point for follow-up. RESULTS: The mean age was 62.8 ± 0.57 years, eGFR 40 ml/min/1.73 m2, median NLR was 2.76. NLR increased as the CKD-stage increased. Mean follow-up time was 51.2 ± 30 months and 21.4% of patients reached the end-point. NLR was significantly increased at follow-up (from 3.22 to 5.68, p < 0.001). Annual GFR loss and baseline CRP were higher but baseline albumin and GFR were lower of patients with high NLR. The percent of patients reaching the end-point was not different between the groups with high and low baseline NLR. Kaplan Meier analysis showed that patients with high NLR had significantly lower mean renal survival (86.5 months) than patients with low NLR (105 months) (p < 0.001). In the Cox-regression analysis NLR was not an independent predictor in reaching the end-point but presence of diabetes mellitus, younger age and low baseline eGFR were found effective. CONCLUSIONS: NLR is an indicator of inflammation in chronic kidney disease. It may not be an independent predictor of CKD progression except that the CKD is in a more advanced stage and reflects the associated inflammation. Classical risk factors such as DM and lower GFR are more powerful predictors of progression.
Subject(s)
Leukocyte Count/methods , Lymphocytes , Neutrophils , Renal Insufficiency, Chronic , Aged , Disease Progression , Female , Follow-Up Studies , Glomerular Filtration Rate , Humans , Inflammation/blood , Male , Middle Aged , Predictive Value of Tests , Proteinuria/diagnosis , Proteinuria/etiology , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/immunology , Renal Insufficiency, Chronic/therapy , Renal Replacement Therapy/methods , Renal Replacement Therapy/statistics & numerical data , TurkeyABSTRACT
BACKGROUND: Accurate measurement of surgical outcomes, proper evaluation of hospitals and surgeons regardless of case can be performed by mortality prediction models. The aim of this study was to analyze factors affecting mortality, present our clinical experience and patient profile and evaluate different scoring systems in use of these patients. METHODS: A retrospective review of one hundred and twelve geriatric patients who underwent major abdominal emergency surgery between 2004 and 2008 was performed. APACHE II, ODIN, SAPS II expanded, P-POSSUM, Manheim peritonitis and Charlson comorbidity index, Goldman and ASA scores were calculated using patient data. Sensitivity, positive predictive value and Odd's ratio were calculated to predict the mortality for these scoring systems. RESULTS: The overall mortality rate for our patients was found 33.9%. The factors affecting mortality in this study were found to be the duration of initial complaint, requirement of intensive care unit, requirement of mechanical ventilation and its duration, the presence of coexisting disease and peritonitis. CONCLUSION: According to our study, in this particular group of patients, APACHE II scoring system is more valid and accurate in estimating the mortality risk when compared to other scoring systems.
