NURS 4342 Nursing Research


To conduct a systematic study to determine the effect of reduced kidney function in CKD in cognitive function in elderly.

These are the key review questions:

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1) What is the relationship between CKD elderly patients with a reduced eGFR and the cognitive function?

2) What is the relationship between the eGFR level of elderly CKD suffers and the rate cognitive decline?

Answer to Question: NURS 4342 Nursing Research

Title of the Study

This current study focuses on the issue of a systematic review on chronic kidney disease and its impact on cognitive function.Research question

How can chronic kidney disease impact cognitive function?

Research objectives and goals

This research is designed to investigate the possible link between impaired renal filtration rate and cognitive function in patients with chronic kidney diseases.


What is the impact of the estimated glomerular-filtration rate of cognitive loss in patients with chronic renal disease?

The goal of the research was to find a link between estimated glomerularfiltration rate (eGFR), as well as its effects on the cognitive function.

Further support could come from neuro-imaging testing and results.

It shows that individuals who have defective glomerularfiltration are more likely to suffer from brain infarctions.

O’Lone, et al. showed that white lesions were more common in those suffering from lower eGFR. 2016).

A low eGFR level can lead to an increase in uremic toxins (creatinine, guanidine), which activates Nmethyl-D-aspartate and gamma aminobutyric acid receptors. 2016).

This could cause cognitive impairment and block the effectiveness of neurotransmitters.

Criteria for eligibility

Secondary methods of data collection were used to gather the data.

These data were obtained from secondary databases or journals.

Secondary data have been gathered from various peer-reviewed journals, government statistics reports and official statistics.

The linking with cohort journals facilitates the possibility of reaching an agreement about the problem.Types Of Studies

This data was gathered by peer-reviewed journals that mainly focus on cohort studies.

These journals aim at establishing a relationship between possible outcomes and health risk.

Also, journals published in English in the last 10 year have not been considered for this review.Types Of Participants

To gather data, peer-reviewed journals were used that estimate present health conditions using eGFR.

Participants with different backgrounds were asked for their data.

Data generation was restricted to elderly persons over 65 years of age.

The elderly without any history of cardiovascular disease or dementia were also included in the comparative analysis.

Types of Interventions

Many intervention strategies were implemented to ensure that the chronic kidney disease sufferers are treated and cared for in the best possible way.

Here are some basic intervention strategies that can be implemented to manage blood glucose and blood pressure.

Patients with CKD are at 15% higher risk of developing heart disease. The risk goes up to 20% if the patient has diabetes. 2014).

Stain and Aspirin are effective medications that can be given to patients to prevent the progression of cardiovascular diseases.

Macedo argued that community-based, nurse-driven care strategies could be used to help control and prevent chronic kidney disease in a quarter of the population. 2014).

In order to obtain data on the present and future health of the people receiving care, audit and recall calls could be used.

Types of Outcome Measures

A variety of programs were established to treat chronic kidney diseases.

Some of the most prominent quality care assessment tools by Rand Corporations could have been mentioned here.

The test is used to screen for CKD regularly in patients with hypertension and diabetes.

The National Committee for Quality Assurances Healthcare Effectiveness Data & Information states that non-steroidal drugs or COX-2 inhibits could be used for treatment and prevention for those with lower estimated glomerular filtration.

Search Strategy and Information Sources

When making relevant searches, there were many factors to consider. The factors which were included or not were then taken into account.

Therefore, only peer reviewed journals relevant to the topic were selected for the purpose of this study.

Additional data was also collected from a number secondary databases and resource such as EMBASE. MEDLINE. CINAHL. SIGLE were just a few.

The data found in languages other then English were deleted during the search hits.

The journal was not published for the past ten decades had also been considered.

Prisma model is an excellent tool for further research. It has six major components and is based on the coordination among services and the point of entrance. The management of the case can be analyzed through unique tools. Access individual service plans and gain relevant information via tools.

Methods for Review

Secondary data collection methods have been chosen to review data that has been sufficiently gathered from peer-reviewed journals, as well other databases.

The peer-reviewed journals in which data was collected from participants suffering from chronic kidney disease or with cardiovascular disease were the only ones that were considered.

This was done to examine the relationship between CKD (and its effects on other related physical conditions, as well cognitive decline).

Assessment Of Methodological Quality

The current study uses a positivist research method, which focuses primarily on data collection through well-representated facts or theories.

Additionally, the researcher’s responsibility is limited to the collection and interpretation data through an objective approach.

To gather data, the researcher used a deductive method. These case studies are well-published.

This design is an exploratory design that serves as a precursor of quantitative data collection.

Thematic analysis was used for further extraction.

The sample was selected from a list of journals using a screening process.

Journals which only review people over 65 with a lower estimated rate of glomerular filtration were excluded.

Data Extraction from Systematic Reviews


Key Items

Title of journal

1.Anemia, cognitive decline and risk in chronic renal disease2.

With cognitive decline, the age of the elderly is often associated with kidney function.

AuthorsKurella et al. (2016); Buchman et al. (2009)

Type of study/design

Quantitative studies with cross-sectional designParticipants

The total number of participants with chronic renal impairments and renal inefficiency was 905

The participants were also shown to have a decline of basic cognitive abilities.


This study involved 825 participants, aged 21 to 70 years with renal disorders. Participants were selected from African American Centre for Kidney Disease and other cohort studies centres.

For the second method, 80 patients with CKD IV and CKD III were put on dialysis together with those receiving haemodialysis or who are in the terminal stages of renal impairment.

Another criteria for exclusion included those above 55 who had HIV infection, stage III or IV of heart failure, cirrhosis and renal carcinoma.

Index tests (data gathering)

Here, Chronic Renal Impairment Cohort (CRIC), baseline serum test and (BSA) were used to test for the presence of chronic kidney disease among adults with mild to moderate CKD.

VariablesIndependent variable : eGFR levels

Cognitive function: Dependent variable

Take a look at the sample size

The sample size taken here was 75. There were equal numbers of people from each of four clinical centers.Missing data

To manage missing data, complete case analysis with imputation is necessary.Model development

Geo-scientific modeling development (GMD), has been used in this instance. It is different from other scientific journals.

To encourage scientific discussion, and to allow publication of journals, this has been done to maximize the internet’s potential.

Statistical evaluation

Analyses using logistic regression models were used to test the association between lower levels eGFr and cognitive impairment.

ANOVA was used for continuous data and ANOVA was used for categorical data.

The model took into account a variety of factors like age, sex, education, centre, and other factors such a presence of hypertension/depression, diabetes/coronary heart disease (eGFR), along with other factors.


Only 27% of the 905 patients were able to show Hb levels below the threshold.

Anemia was the most common co-variable. It was seen in 46 %, which included participants with lower education levels.


The study examined the possibility of lower cognitive functions being associated with decreased eGFR (or defective kidney function).

Chronic kidney diseases often have strong correlations with other co-morbid conditions like hypertension, cardiovascular disease, and hypertension.

These diseases are most common in old age. However, additional research and investigation in this area is necessary.


The association between CKD-related cognitive decline is only indicative of sub-cortical vascular disease.

Therefore, research into the impact of low eGFR on cognitive decline is very limited.

Therefore, only proper brain imaging and tests could be used to evaluate the effect of low eGFR on cognitive decline.


It was therefore possible to identify the relationship between cognitive function and eGFR levels when large numbers were recruited.

Diverse tests were used to validate the data further.Table: Data extraction tool

(Source: Researcher.)


Methodical approaches were used to gather and extract data.

The study was performed at several cohort centers, including the African American Centre for Kidney Disease.

A variety of renal impairments were identified in these participants.

In addition, the cohort study group included CKD patients with types III, IV, V.

Data were also analyzed with simple Chi-square and ANOVA.

The test was also able to identify a link between cognitive decline, renal impairment, and the presence of dementia.

Data Synthesis

The data was synthesised by mixed statistical methods, such as logistic regression model or Pearson correlation.

The Pearson correlation was used for accessing the bivariate relations of kidney with cognition as well as other co-variants such high blood pressure and diabetes.

Further, continuous variables chosen for the test were expressed in means +/– standard deviation.

These variables were further compared by chi square and t tests to group related and dissimilar groups.

Description of Selected Studies

Two types of tests were used for this study: the Chronic Renal Impairment Cohort and Baseline Serum Tests.

The tests were done in multiple centers with several participants.

CRIC tests involved participants from various age groups. These participants were randomly selected in different areas of the United States.

However, the study revealed a strong correlation in low eGFR levels and decreased cognition.

Basal Serum Test (which was used on 886 elderly Chicagoans) was one of the other methods.

The modification of diet in kidney disease formula was used to perform the test.

The cognitive tests were used to correlate kidney impairment with eGFR levels lower than or greater than 60 ml/min.

60 ml/min remained the threshold.

Methodological Quality

The CHARMS list has been used for data extraction and critical appraisal in systematic reviews.

It consists of 11 parameters that were used for evaluation and appraisal.

It describes the source, participants, and predicted outcomes.

It also explains the methods used to arrive a satisfactory result from the tests.

It also contains information about the model’s performance and development.

Due to the increased number of measurement tools in health, a systematic review is crucial.

A methodological quality is vital for analyzing a problem.

In this case, the accuracy of the method guarantees that the gathered data are valid and can be used for future analysis.

However, misleading results could be generated if incorrect or faulty data is used.Result Of Individual Studies

It was clear from the evaluation that impaired kidney function was associated to loss semantic memory, working memory, and other cognitive abilities.

Additionally, a lower estimated glomerular rate could cause a reduction in cognitive abilities.

A lower estimated glomerular filtration rate (eGFR) of 30 ml/min could cause a 47% increase of the chance of a person’s cognitive decline.

Participants had to complete a Modified Mental State Examination (3 MS), to check a few basic cognitive abilities.

The testing parameters included concentration, orientation memory, language and praxis.

The patients receiving health care were shown to have difficulty making decisions when their EGFr levels are lower (Kurella Tsubura 2016).Baseline serum test

The baseline serum is the second test. This measures the amount of creatinine found in an individual’s blood.

The test indicated anomalies beyond the acceptable normal standards.

This test has shown that almost 38% (or more) of 65-year-olds had eGFR levels under 60ml /min.

Research and studies have demonstrated a strong correlation between kidney disease and cognitive decline (Kurella. 2004).

An abnormality in the kidney’s functioning is indicated by creatinine levels exceeding 1.2 in women and above 1.4 men.

The glomerular flow rate is a measure of how fast the kidneys can remove waste products.

So, a lower eGFR value than 60 can indicate that medical intervention may be required.

Additionally, a fall of 15 or more can signal serious problems such as kidney damage.

This study found that nearly 20% of women with eGFr levels of 45-59ml had cognitive decline.

The correlation between multiple tests in similar domains measuring cognition of patients with CKD was established.

The analysis revealed that the patients with lower eGFR levels had always had high creatinine levels. These could cause brain shocks or other fatal conditions (Lamb, 2014.

Also, higher levels of toxin like creatinine can inhibit the enzymatic activities of neurotransmitters including gamma amino butyric acid.

Limitations of systematic review

In this setting, the study was carried out with the help of peer-reviewed journal.

Accessibility problems resulted from a number of journals that were paid.

Accessibility to the journals in languages other that English is also a problem.


This study helped to understand that there is a strong association between low levels estimated glomerularfiltration rate and declines cognitive abilities.

This could be explained by the higher concentration of uremic, such as creatinine and Guanidine, which act like acid block receptors.

This could lead to a decrease in signal transmission and nervous stimulation.

The current study sought to find a connection between the unusually low eGFR levels as well as its relationship to cognitive decline.

But, this particular area is still a new field of research.

Furthermore, the study could be more useful by presenting the sources as a way to demonstrate a link between cognition (eGFR) and this area.

The other co-variants are also being considered. This is what makes the study so important.

The malfunctioning of one’s kidney could also explain anomalies in the concentration of blood.

Research implications

Because this research was exploratory and interpretive, there is plenty of scope for future analysis and research.

It attempts to fulfill both the further development and validation of established theories.

However, there are always limitations to the research and additional research must be done in the future to improve the subject.

Refer toHill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O’Callaghan, C. A., Lasserson, D. S., & Hobbs, F. R. (2016).

Global prevalence and treatment of chronic kidney disease-a meta-analysis and systematic review.

PLoS One. 11(7). p.1587.Lamb, E. J., Brettell, E. A., Cockwell, P., Dalton, N., Deeks, J. J., Harris, K., … & Ottridge, R. S. (2014).

The eGFRC study: accurate estimation of glomerular filtration ratio (GFR), using creatinine and cystatin, as well as albuminuria, for monitoring disease progression among patients with stage 3 chronic renal disease. A prospective longitudinal study in a multiethnic patient population.

BMC Nephrology 15, p.13.Macedo, A. F., Taylor, F. C., Casas, J. P., Adler, A., Prieto-Merino, D., & Ebrahim, S. (2014).

Unintended effects of statins based on observational studies in general population: systematic review & meta-analysis. BMC medicine, 12(1), p.51.Murray, A. M., Bell, E. J., Tupper, D. E., Davey, C. S., Pederson, S. L., Amiot, E. M., … & Foley, R. N. (2016).

Cohort Study on Brain in Kidney Disease (BRINK). Design. Baseline cognitive function.

American Journal of Kidney Diseases. 67(4). 593-600.O’Hare, A. M. (2009).

The Management Of Elderly People with a Low EGFR: Moving toward an Individualized Approach.

American Journal of Kidney Diseases

: The Official Journal of the National Kidney Foundation. 53(6), 925-927. Retrieved from’Lone, E., Connors, M., Masson, P., Wu, S., Kelly, P. J., Gillespie, D., … & Craig, J. C. (2016).

A systematic review of the literature and meta-analysis on cognition in patients with endstage kidney disease.

American Journal of Kidney Diseases., 67(6). 935-935.Walker, S. R., Wagner, M., & Tangri, N. (2014).

A review on chronic kidney disease and frailty.

Journal of Renal Nutrition. 24(6), 364–370.

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Cognitive impairment in elderly dialysis patients and people with chronic kidney diseases: An occult cost.

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The Health, Ageing, Body Composition study: Chronic kidney disease, cognitive impairment, and elderly.

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Cystatin C and measures for physical function in elderly people: The Health, Aging, and Body Composition, (HABC), Study. Am J Epidemiol 2006;164:1180-1189. Fried LF, Lee JS, Shlipak M et al.

Chronic kidney disease, functional limitation, and functional limitations in older persons: Health and ageing.

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Slinin Y. Paudel ML. Taylor BC. Fink HA. Ishani AH. Canales MT. Yaffe K. BarrettConnorE. Orwoll ES. Shikany JS. Leblanc ES. Cauley JA. Ensrud KE. 25HydroxyvitaminD levels and cognitive decline in elderly men.

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Kurella Tamura and others. (2016). Anaemia and risk of cognitive impairment in chronic kidney disease. Retrieved from: