Delirium accompanies kidney dysfunction in hospitalized elderly patients

Giuseppe Coppolino 1, Alberto Castagna 2, Michele Provenzano 1, Carmen Ruberto 2, Giuseppe Leonardi 1, Laura Greco 3, Giorgio Giovanni Battaglia 4, Rosa Paola Cerra 3, Michele Andreucci 1, Davide Bolignano 5, Giovanni Ruotolo 3

1 Department of Health Sciences, Renal Unit, “Magna Graecia” University, Catanzaro, Italy; 2 Azienda Sanitaria Provinciale di Catanzaro, Center for Cognitive Disorders and Dementia, Catanzaro, Italy; 3 Geriatric Unit, “Pugliese-Ciaccio” General Hospital, Catanzaro, Italy; 4 Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy; 5 Department of Medical and Surgical Sciences, Renal Unit, “Magna Graecia” University, Catanzaro, Italy

Introduction. Delirium, defined as an acute mental status with altered level of consciousness, is a common geriatric syndrome and a typical complication in hospitalized elderly patients. We aimed to assess the occurrence of delirium and the possible relationship with renal impairment.

Methods. Patients aged over 65 years admitted consecutively to a Geriatric Unit, were screened for a first diagnosis of delirium. Delirium was evaluated using the validated Assessment Test for Delirium and Cognitive Impairment (4AT). 

Results. Final analysis included 311 patients (182 women,129 men). Mean eGFR was 62.44 ± 28.84 mL/min/1.73 m2. Prevalence of Cognitive impairment or delirium was 5.4, 84.8 e 9.8% for 0, 1-3 and ≥ 4 4AT scores. At univariate analysis, prevalence of clear delirium was increased with the worsening of CKD, being 3.7% in stage IIIb up to 68% in stage IV-V (p < 0.001). At multivariable logistic analysis, adjusted for gender and smoking habit, higher eGFR levels were associated with a reduced risk for the presence of delirium (OR = 0.86 95% CI 0.82-0.91, p < 0.001) and for developing possible cognitive impairment (OR = 0.87 95% CI 0.83-0.90, p < 0.001). 

Discussion. Mild to moderate delirium is a pervasive condition among geriatric patients with manifested renal function impairment.

Download PDF