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Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy

View Article: PubMed Central - PubMed

ABSTRACT

Chronic kidney disease (CKD) is a highly prevalent condition in the world. Neurological, psychological, and cognitive disorders, related to CKD, could contribute to the morbidity, mortality, and poor quality of life of these patients. The aim of this study was to assess the neurological, psychological, and cognitive imbalance in patients with CKD on conservative and replacement therapy.

Seventy-four clinically stable patients affected by CKD on conservative therapy, replacement therapy (hemodialysis (HD), peritoneal dialysis (PD)), or with kidney transplantation (KT) and 25 healthy controls (HC), matched for age and sex were enrolled. Clinical, laboratory, and instrumental examinations, as renal function, inflammation and mineral metabolism indexes, electroencephalogram (EEG), psychological (MMPI-2, Sat P), and cognitive tests (neuropsychological tests, NPZ5) were carried out.

The results showed a significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (P = 0.008, P < 0.001, P = 0.051), a positive correlation between relative power of delta band and C-reactive protein (CRP) (P < 0.001) and a negative correlation between estimated glomerular filtration rate (eGFR) (P < 0.001) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) (P < 0.001), in all the samples. Qualitative analysis of EEG showed alterations of Grade 2 (according to Parsons–Smith classification) in patients on conservative therapy, and Grade 2–3 in KT patients. The scales of MMPI-2 hysteria and paranoia, are significantly correlated with creatinine, eGFR, serum nitrogen, CRP, 1,25-(OH)2D3, intact parathyroid hormone (iPTH), phosphorus, and cynical and hysterical personality, are correlated with higher relative power of delta (P = 0.016) and theta band (P = 0.016). Moreover, all NPZ5 scores showed a significant difference between the means of nephropathic patients and the means of the HC, and a positive correlation with eGFR, serum nitrogen, CRP, iPTH, and vitamin D.

In CKD patients, simple and noninvasive instruments, as EEG, and cognitive-psychological tests, should be performed and careful and constant monitoring of renal risk factors, probably involved in neuropsychological complications (inflammation, disorders of mineral metabolism, electrolyte disorders, etc.), should be carried out. Early identification and adequate therapy of neuropsychological, and cognitive disorders, might enable a better quality of life and a major compliance with a probable reduction in the healthcare costs.

No MeSH data available.


Related in: MedlinePlus

EEG visual analysys classification according to the Parsons–Smith grading. Grade 1: normal EEG, Grade 2: distinctive features of encephalopathy, Grade 3: signs of severe encephalopathy. CKD = chronic kidney disease, HC = healthy controls, HD = hemodialysis, KT = kidney transplantation, PD = peritoneal dialysis.
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Figure 2: EEG visual analysys classification according to the Parsons–Smith grading. Grade 1: normal EEG, Grade 2: distinctive features of encephalopathy, Grade 3: signs of severe encephalopathy. CKD = chronic kidney disease, HC = healthy controls, HD = hemodialysis, KT = kidney transplantation, PD = peritoneal dialysis.

Mentions: The quantitative analysis of EEG data, showed a significant difference, between CKD patients and HC, of the relative and absolute power of delta band (P < 0.001, P = 0.008) (Table 2), more evident in PD patients (Fig. 1), of the relative power of theta band (P = 0.051), more evident in HD patients (P = 0.019) and of the relative and absolute power of Beta1 band (P = 0.012, P = 0.022) (Table 2). The qualitative analysis of EEG data, showed more regular and stable EEG, on conservative therapy and KT patients, (most represented Grade 1 scale Parsons–Smith) (Fig. 2), respect to HD and PD patients (greater Grade 2 and 3 scale Parsons–Smith). However, also in conservative therapy patients, EEG showed a lower percentage of Grade 2 and even Grade 3 on KT patients, respect to HC (Fig. 2). Bivariate analysis showed a negative correlation between relative power of delta band and 1,25-(OH)2D3 (Fig. 3), MDRD value (Fig. 4), and the TMT of NPZ5 score (r = 0.235, P = 0.043), and a positive correlation with CRP value (Fig. 5) and ESV (r = 0.418, P < 0.001) in all the samples.


Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy
EEG visual analysys classification according to the Parsons–Smith grading. Grade 1: normal EEG, Grade 2: distinctive features of encephalopathy, Grade 3: signs of severe encephalopathy. CKD = chronic kidney disease, HC = healthy controls, HD = hemodialysis, KT = kidney transplantation, PD = peritoneal dialysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134816&req=5

Figure 2: EEG visual analysys classification according to the Parsons–Smith grading. Grade 1: normal EEG, Grade 2: distinctive features of encephalopathy, Grade 3: signs of severe encephalopathy. CKD = chronic kidney disease, HC = healthy controls, HD = hemodialysis, KT = kidney transplantation, PD = peritoneal dialysis.
Mentions: The quantitative analysis of EEG data, showed a significant difference, between CKD patients and HC, of the relative and absolute power of delta band (P < 0.001, P = 0.008) (Table 2), more evident in PD patients (Fig. 1), of the relative power of theta band (P = 0.051), more evident in HD patients (P = 0.019) and of the relative and absolute power of Beta1 band (P = 0.012, P = 0.022) (Table 2). The qualitative analysis of EEG data, showed more regular and stable EEG, on conservative therapy and KT patients, (most represented Grade 1 scale Parsons–Smith) (Fig. 2), respect to HD and PD patients (greater Grade 2 and 3 scale Parsons–Smith). However, also in conservative therapy patients, EEG showed a lower percentage of Grade 2 and even Grade 3 on KT patients, respect to HC (Fig. 2). Bivariate analysis showed a negative correlation between relative power of delta band and 1,25-(OH)2D3 (Fig. 3), MDRD value (Fig. 4), and the TMT of NPZ5 score (r = 0.235, P = 0.043), and a positive correlation with CRP value (Fig. 5) and ESV (r = 0.418, P < 0.001) in all the samples.

View Article: PubMed Central - PubMed

ABSTRACT

Chronic kidney disease (CKD) is a highly prevalent condition in the world. Neurological, psychological, and cognitive disorders, related to CKD, could contribute to the morbidity, mortality, and poor quality of life of these patients. The aim of this study was to assess the neurological, psychological, and cognitive imbalance in patients with CKD on conservative and replacement therapy.

Seventy-four clinically stable patients affected by CKD on conservative therapy, replacement therapy (hemodialysis (HD), peritoneal dialysis (PD)), or with kidney transplantation (KT) and 25 healthy controls (HC), matched for age and sex were enrolled. Clinical, laboratory, and instrumental examinations, as renal function, inflammation and mineral metabolism indexes, electroencephalogram (EEG), psychological (MMPI-2, Sat P), and cognitive tests (neuropsychological tests, NPZ5) were carried out.

The results showed a significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (P&#8202;=&#8202;0.008, P&#8202;&lt;&#8202;0.001, P&#8202;=&#8202;0.051), a positive correlation between relative power of delta band and C-reactive protein (CRP) (P&#8202;&lt;&#8202;0.001) and a negative correlation between estimated glomerular filtration rate (eGFR) (P&#8202;&lt;&#8202;0.001) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) (P&#8202;&lt;&#8202;0.001), in all the samples. Qualitative analysis of EEG showed alterations of Grade 2 (according to Parsons&ndash;Smith classification) in patients on conservative therapy, and Grade 2&ndash;3 in KT patients. The scales of MMPI-2 hysteria and paranoia, are significantly correlated with creatinine, eGFR, serum nitrogen, CRP, 1,25-(OH)2D3, intact parathyroid hormone (iPTH), phosphorus, and cynical and hysterical personality, are correlated with higher relative power of delta (P&#8202;=&#8202;0.016) and theta band (P&#8202;=&#8202;0.016). Moreover, all NPZ5 scores showed a significant difference between the means of nephropathic patients and the means of the HC, and a positive correlation with eGFR, serum nitrogen, CRP, iPTH, and vitamin D.

In CKD patients, simple and noninvasive instruments, as EEG, and cognitive-psychological tests, should be performed and careful and constant monitoring of renal risk factors, probably involved in neuropsychological complications (inflammation, disorders of mineral metabolism, electrolyte disorders, etc.), should be carried out. Early identification and adequate therapy of neuropsychological, and cognitive disorders, might enable a better quality of life and a major compliance with a probable reduction in the healthcare costs.

No MeSH data available.


Related in: MedlinePlus