#3751 The comparison of cognitive function in chronic kidney disease patients on renal replacement therapy in Albania

Abstract Background and Aims Change in cognitive function (CF) is one of the known consequences of end stage renal disease (ESRD). Cognitive impairment (CI) is likely to become an increasingly important public health issue in the ESRD population, but little is known about the influence of different therapy modalities on cognitive function. The aim of this study was to determine the frequency of CI in patients on hemodialysis (HD) and to compare them with patients undergoing peritoneal dialysis (PD), renal transplantation (Tx) and a control group. Method We assessed various cognitive abilities in 62 patients on renal replacement therapy (RRT) and compared the effect of renal treatment on cognitive abilities with a control group of 57 individuals. Throughout this analysis, we used age and education level as criteria to define the sample and control groups. CF was estimated using the MOCA test. Paired t-test and ANOVA test were used to obtain the results. Results Individuals involved in the analyses are in the age group of 25–50 years, with a mean of 34.5 years for the control group and 37.16 years for the sample patients. ANOVA test confirms that there is no difference between the age and educational level of individuals involved in the analyses with kidney disease (sample) vs. those with no kidney disease (control groups). The prevalence of normal cognition is 47.4% in the control group and 27.4% in the observed patients. Mild cognitive impairment is 52.6% for the control group and 64.5% for the patients, while moderate/severe cognition with a prevalence of 8.1% is observed only in patients with chronic kidney disease (see Fig. 1). Severe CI is observed only among patients with HD. Moderate CI has a prevalence of 13% among HD patients while lowering to 8% for PD patients and just 1% among TX. Among chronic kidney disease patients on renal replacement therapy, we found an improvement in cognitive performance in transplanted patients (see Fig. 2). The overall MOCA score for the control group was 25.57, while the mean MOCA score for the patient sample was 22.61. The paired t-test shows that this difference is statistically different. We analyzed all the components of the CI assessment and tested the statistical differences between the control and observed patients. The paired t-test for the mean difference shows that attention and cognitive skills that help people perform actions are statistically lower for observed patients if compared to a control group. To further analyze how cognitive abilities differ among patients with kidney disease and the control group, we used ANOVA (analysis of variance), which corrects for any bias in testing if non-constant variance). We found evidence that there is a statistical difference in cognitive ability between control and observed patients that affects their ability to name things and recall events from the past. Patients with kidney disease manifest as well a lower ability to use language. Abstraction skills do not appear to manifest differences between control and observed patients (see ANOVA results). Conclusion CI is an important problem in chronic kidney disease and RRT, regardless of the modality used, even in non-elderly patients. We found that renal transplantation as a treatment modality in ESRD patients is superior to HD and PD in terms of cognitive performance improvement. We also found that cognitive problems may occur earlier and more frequently in PD patients than in the general population, but with a lower incidence than in HD patients. These considerations are important to communicate to patients when choosing between the different replacement modalities.