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Cognitive Impairment in Kidney Disease

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ClinicalTrials.gov Identifier: NCT00905619
Recruitment Status : Completed
First Posted : May 20, 2009
Last Update Posted : August 18, 2017
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:

An increasing number of Veterans are anticipated to develop chronic kidney disease (CKD) and require hemodialysis (HD) treatments as the Veteran population ages. In 2003, approximately 290,000 US citizens were receiving HD and an estimated 19 million were affected by CKD. The annual growth rate is predicted to be 7% per year with 500,000 Americans receiving HD treatment by 2010. In 2005, approximately 2500 Veterans were receiving HD with growth expected to parallel that seen in the general population. Whereas Alzheimer's disease is the leading cause of dementia in the general population, growing evidence suggests that patients with advanced CKD experience cognitive deficits related to accelerated cerebrovascular disease. Patients with advanced CKD have been shown to have a high prevalence of sub-clinical cerebrovascular damage on imaging studies and a heavy burden of vascular risk factors such as diabetes, elevated cholesterol, and hypertension. Many of the cognitive deficits related to cerebrovascular disease may go unrecognized by routine measures of cognition. HD patients have increased number of hospitalizations, and several compliance issues ranging from congestive heart failure to dangerous electrolyte imbalances. Impaired cognition in this population is likely to have a significant impact on self-care and compliance with complex medical regimens. Currently, the severity and scope of cognitive impairment related to vascular disease is not well known in patients with advanced kidney disease. Additionally, the relationship between cognitive impairment and measures of self-care independence are not well known. Loss of independence and function secondary to impaired cognitive function is likely to be a significant problem for patients with advanced kidney disease. Early identification of functional impairment, particularly instrumental activities of daily living (IADL), will allow for rehabilitation intervention. Maintaining or improving functional independence through intensive rehabilitation could translate into better compliance and lower hospitalization rate among HD patients. Information obtained from this study is likely to heighten awareness of cognitive impairment and the functional consequences in Veterans with advanced kidney disease. Primary objectives are to determine:

  1. The range of cognitive deficits with emphasis on domains affected by vascular disease in patients with advanced CKD and those receiving hemodialysis.
  2. The associations between severity of cognitive impairment and severity of kidney disease.
  3. The prevalence of impaired IADLs and the level of health-related quality of life (HRQOL) in patients with advanced CKD and those requiring hemodialysis.
  4. The relationship or association of cognitive impairment with IADL and HRQOL.

Secondary objective is to determine:

1. The relationships among cerebral and carotid blood flow, carotid artery stiffness, and renal specific metabolic abnormalities with cognitive impairment.


Condition or disease
Kidney Insufficiency, Chronic

Study Type : Observational
Actual Enrollment : 117 participants
Observational Model: Case-Crossover
Time Perspective: Cross-Sectional
Official Title: Functional and Cognitive Impairment in Advanced Kidney Disease
Actual Study Start Date : December 1, 2006
Actual Primary Completion Date : September 28, 2012
Actual Study Completion Date : July 20, 2017

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Kidney Diseases

Group/Cohort
Control
No kidney disease
PreHD kidney disease
Kidney disease stage 4 or below
Hemodialysis
Kidney disease receiving hemodialysis



Primary Outcome Measures :
  1. Neuropsychological Assessments [ Time Frame: 1 year ]
    battery of neurocognitive tests


Biospecimen Retention:   Samples Without DNA
Serum obtained and kept until end of study.


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 89 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Veterans at the Bronx VA Renal Clinic, Hemodialysis Unit, and Primary Care Clinic
Criteria

Inclusion Criteria:

PreHD Subjects:

  • Male or female with an age of 18 years or older (no upper limit);
  • Patients with stage III-IV CKD attending the renal primary care clinic or renal consult clinic;
  • Fluent in English;
  • Outpatient or stable nursing home patient

HD Subjects:

  • Receiving HD for at least two weeks;
  • Male or female with an age of 18 years or older (no upper limit);
  • Fluent in English;
  • Outpatient or stable nursing home patient

Control Subjects:

  • Glomerular filtration rate of 60 cc/minute or greater;
  • Male or female with an age of 18y or older (no upper limit);
  • Fluent in English
  • Outpatient

Exclusion Criteria:

PreHD Subjects:

  • Acute illness;
  • Clinical history of stroke, dementia, or Parkinson's disease;
  • Hb <10;
  • Liver function tests 2x upper limit of normal;
  • Hemodialysis

HD Subjects:

  • Acute illness;
  • Clinical history of stroke, dementia, or Parkinson's disease;
  • Hb <10;
  • Liver function tests 2x upper limit of normal;
  • URR <65% (measure of dialysis adequacy: will use 3-month average from chart)

Control Subjects:

  • Acute illness;
  • Clinical history of stroke, dementia, or Parkinson's disease;
  • Hb <10;
  • Liver function tests 2x upper limit of normal;
  • Stage 3-4 CKD;
  • Hemodialysis

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00905619


Locations
United States, New York
James J. Peters VA Medical Center, Bronx, NY
The Bronx, New York, United States, 10468
Sponsors and Collaborators
VA Office of Research and Development
Investigators
Principal Investigator: James B Post, MD VA Office of Research and Development

Publications of Results:
Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT00905619     History of Changes
Other Study ID Numbers: B5050W-1
First Posted: May 20, 2009    Key Record Dates
Last Update Posted: August 18, 2017
Last Verified: August 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
Kidney Diseases
Cognitive Dysfunction
Renal Insufficiency
Renal Insufficiency, Chronic
Urologic Diseases
Cognition Disorders
Neurocognitive Disorders
Mental Disorders