Addressing cognitive impairment in peritoneal dialysis: a systematic review and meta-analysis of prevalence, risk factors, and outcomes

Background. Cognitive impairment (CI) is a critical complication in peritoneal dialysis (PD) patients, associated with decreased quality of life and increased hospitalization. Despite its significant impact, the prevalence, risk factors, and consequences of CI in PD patients are not well understood. We aimed to determine the prevalence, risk factors, and outcomes of CI in PD patients. Methods. We performed systematic reviews in OVID Medline, Embase, and Cochrane databases until February 2024 to identify cross-sectional and cohort studies on prevalence of CI (identified by cognitive assessment scales) in PD patients. The Newcastle-Ottawa Scale was used to assess risk of bias. A pooled meta-analysis of CI prevalence in PD and a subgroup analysis comparing the risk of CI between PD and non-PD settings were performed using a random-effects model. Results. A total of 19 studies were identified, involving 2882 PD patients. The pooled prevalence of CI in PD patients was 47.7% (95%CI: 35.8-59.9%). CI in patients undergoing PD appears to be associated with older age, female gender, lower levels of education, and is linked to higher rates of hospitalization and peritonitis, compared to those without CI. However, it is not associated with increased mortality. Compared to hemodialysis, PD showed a trend toward a lower risk of CI (OR 0.64, 95%CI 0.39-1.03; P = .068). Conclusion. CI is highly prevalent and associated with several adverse clinical outcomes in PD patients. These findings could contribute to facilitate the development of screening and early intervention strategies to reduce the burden of disease in this population.