2 research outputs found
PowerPoint Slides for: Cognitive Impairment in Advanced Chronic Kidney Disease: The Canadian Frailty Observation and Interventions Trial
<i>Background:</i> Chronic kidney disease (CKD) affects more than one third of older adults, and is a strong risk factor for vascular disease and cognitive impairment. Cognitive impairment can have detrimental effects on the quality of life through decreased treatment adherence and poor nutrition and results in increased costs of care and early mortality. Though widely studied in hemodialysis populations, little is known about cognitive impairment in patients with pre-dialysis CKD. <i>Methods:</i>Multicenter, cross-sectional, prospective cohort study including 385 patients with CKD stages G4-G5. Cognitive function was measured with a validated tool called the Montreal Cognitive Assessment (MoCA) as part of a comprehensive frailty assessment in the Canadian Frailty Observation and Interventions Trial. Cognitive impairment was defined as a MoCA score of ≤24. We determined the prevalence and risk factors for cognitive impairment in patients with CKD stages G4-G5, not on dialysis. <i>Results:</i> Two hundred and thirty seven participants (61%) with CKD stages G4-G5 had cognitive impairment at baseline assessment. When compared to a control group, this population scored lower in all domains of cognition, with the most pronounced deficits observed in recall, attention, and visual/executive function (p < 0.01 for all comparisons). Older age, recent history of falls and history of stroke were independently associated with cognitive impairment. <i>Conclusions:</i> Our study uncovered a high rate of unrecognized cognitive impairment in an advanced CKD population. This impairment is global, affecting all aspects of cognition and is likely vascular in nature. The longitudinal trajectory of cognitive function and its effect on dialysis decision-making and outcomes deserves further study
Supplementary Material for: Dipeptidyl Peptidase-4 Inhibitors in Chronic Kidney Disease: A Systematic Review of Randomized Clinical Trials
<p><b><i>Background:</i></b> Chronic kidney disease (CKD) is common in
patients with type 2 diabetes mellitus (T2DM) and limits therapeutic
options. Dipeptidyl peptidase-4 (DPP-4) inhibitors represent a novel
class of oral glucose-lowering agents and are known to be safe and
effective in the general population. <b><i>Methods:</i></b> We searched
Cochrane, EMBASE, and PubMed from the time of their inception until
March 2015. We included randomized controlled trials analyzing the
efficacy (change in hemoglobin A1C [HbA1C]) and safety of DPP-4 agents
in individuals with reduced kidney function (estimated glomerular
filtration rate <60 mL/min/1.73 m<sup>2</sup>). We extracted study
characteristics, participants' baseline characteristics, and safety
outcomes from eligible studies. We performed a random effects
meta-analysis to summarize the change in HbA1C and the relative risk of
cardiovascular events in patients with T2DM and CKD. We also collected
data on hypoglycemia, other serious adverse events, and mortality. <b><i>Results:</i></b>
We reviewed 12 studies with 4,403 patients with CKD and 239 on
dialysis, finding a mean weighted decline in HbA1C of -0.48 (95% CI
-0.61 to -0.35) with DPP-4 inhibitor therapy compared to placebo. DPP-4
inhibitors did not result in any additional adverse events, hypoglycemic
episodes, or increased mortality. Restricting to studies with low risk
of bias did not alter these findings. <b><i>Conclusions:</i></b> DPP-4
inhibitors can lower HbA1C without increasing the risk of cardiovascular
or other major adverse events in patients with CKD. Few studies
reported critical adverse events such as heart failure and
hypersensitivity. If compared with other oral antiglycemic drugs, the
effect of DPP-4 inhibitors is limited; however, their low risk of
hypoglycemia may favor their use in patients with CKD. <b><i>Summary:</i></b>
This systematic review of DPP-4 inhibitors in CKD suggests that they
reduce HbA1C by about 0.5%. Furthermore, there was not any increase in
the risk for significant adverse events. More research is needed to
determine the safety and efficacy of DPP-4 inhibitors in CKD.</p