High Anticholinergic Burden May Impair Physical Function and Quality of Life in Older Adults with Chronic Kidney Disease: A Cross-sectional Study
Anticholinergic Burden and Cognition in CKD
DOI:
https://doi.org/10.5281/zenodo.21747299Keywords:
Activities of Daily Living, Cholinergic Antagonists, Cognitive Dysfunction, Quality of Life, Renal Insufficiency, ChronicAbstract
Background: Older adults with chronic kidney disease are highly vulnerable to polypharmacy. This study aimed to investigate the multidimensional impact of cumulative anticholinergic burden on physical functionality, cognitive performance, and health-related quality of life in this specific population.
Marerial and Methods: In this cross-sectional study, 234 patients with chronic kidney disease were evaluated. The anticholinergic burden was calculated using the updated Anticholinergic Cognitive Burden scale. Physical independence, cognitive status, and health-related quality of life were assessed using the Katz Index of Independence in Activities of Daily Living, the Mini-Cog test, and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire, respectively. Multiple regression models were utilized to adjust for confounders, including age and overall comorbidity burden.
Results: Patients in the high Anticholinergic Cognitive Burden group were significantly older and more likely to be female. The most frequent contributors to the anticholinergic burden were cardiovascular medications, primarily beta-blockers and loop diuretics. In multiple regression analysis, a high anticholinergic burden emerged as a strong, independent predictor of decreased physical independence (Katz Index) and diminished health-related quality of life (EQ-5D-5L) (p < 0.05). Conversely, the initial negative correlation between Anticholinergic Cognitive Burden scores and cognitive performance (Mini-Cog scores) lost its statistical significance after adjusting for age and comorbidity.
Conclusion: Anticholinergic burden may independently impair physical functionality and health-related quality of life in older chronic kidney disease patients, whereas its cognitive impact is heavily mediated by age and comorbidities. Routine medication reviews that prioritize deprescribing cumulative anticholinergics should become a standard component of chronic kidney disease management.
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