Cognitive Dysfunction and Its Risk Factors in Patients Undergoing Maintenance Hemodialysis

Abstract

Objective Cognitive impairment (CI) in Maintenance hemodialysis (MHD) is attracting increasing attention. This study aims to clarify the prevalence and risk factors for cognitive dysfunction in patients on MHD who have no history of stroke. Methods A total of 99 patients with no history of stroke undergoing MHD were enrolled. Global cognitive function was evaluated using the Montreal Cognitive Assessment scale. Attention and executive functions were evaluated by the Digital Span (DS) test and the Color Trail Test (CTT). The Hamilton Depression and Anxiety scales were used to assess depression and anxiety status. The effects of patient background factors, laboratory indicators, anxiety, and depression on cognitive dysfunction were examined by regression analysis. Results There were 69.70% of the patients had general CI, 65.65% had depression, and 57.57% had anxiety. The forward and backward DS in the cognitively impaired (CI) group were shorter than in the normal cognitive function (NCF) group ( P <0.05). Times required for CTT–I, CTT–II, and CTT II − CTT I were longer in the CI group than in the NCF group ( P <0.05). Hemoglobin levels were lower, and parathyroid hormone (PTH) and uric acid levels were higher in the CI group than in the NCF group ( P <0.05). Hemoglobin levels were negatively correlated with CI in these patients (odds ratio [OR] 0.634, P <0.05) and PTH, and uric acid levels were positively correlated with CI (OR 1.028, P <0.05; and OR 1.011, P <0.05). The proportions of patients with diabetes and depression were higher in the CI group ( P <0.05). Conclusion There was a high prevalence of CI with significant impairment of attention and executive ability in MHD patients who had no stroke history. Hemoglobin may protect cognitive function, while diabetes, PTH, and uric acid levels may be risk factors. Depressive and anxiety states may aggravate CI in MHD patients.

Low intracellular water and incident cognitive impairment in chronic hemodialysis patients

“…As described in our previous study, 8 patients' individual data such as comorbid conditions, sociodemographic characteristics, drug usage, blood pressure, dialysis mode, dialysis duration, and biochemistry parameters were collected from the dialysis run sheets, electronic medical record system and a face‐to‐face interview with a predesigned questionnaire. Patients with a high school level were defined as individuals who had received more than 9 years of schooling education.…”

“…Some studies have sought to identify risk factors predisposing to CI, and body composition is one of these factors that have been paid attention 7–10 . Intracellular water (ICW) is a biomarker of cell hydration status and muscle mass.…”

“…Some studies have sought to identify risk factors predisposing to CI, and body composition is one of these factors that have been paid attention. [7][8][9][10] Intracellular water (ICW) is a biomarker of cell hydration status and muscle mass. In elderly individuals with similar muscle mass, those with lower ICW had a worse functional performance and a higher frailty risk, suggesting a harmful effect of cell dehydration, independently of muscle mass.…”

Incidence and risk factors of cognitive dysfunction in hemodialysis patients: A systematic review and meta‐analysis

“…Ten articles [14][15][16][17][18] were finally included in this study, with a total of 5535 hemodialysis patients, including 2033 patients with cognitive dysfunction and 3502 patients with normal cognitive function. Among them, 7 articles were from China, 1 from Germany, 1 from Pakistan, and 1 from Morocco.…”