Impact of uremic toxins on cognitive function in end-stage renal disease patients: the mediating effect of depression

Ying Liu; Junya MU; Ming Zhang; Zhaoyao Luo; Yuanshuo Ouyang; Qingjuan Chen; Yi LI; Wei Chen

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Impact of uremic toxins on cognitive function in end-stage renal disease patients: the mediating effect of depression

VernacularTitle:终末期肾病患者尿毒症毒素对认知功能的影响：抑郁的中介效应
Author: Ying LIU ¹ ; Junya MU ² ; Ming ZHANG ² ; Zhaoyao LUO ² ; Yuanshuo OUYANG ³ ; Qingjuan CHEN ¹ ; Yi LI ⁴ ; Wei CHEN ⁴
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1. Department of Oncology, No. 3201 Hospital of Xi’an Jiaotong University Health ScienceCenter, Hanzhong 723000
2. Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061
3. Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences of Xi’an Jiaotong University Health Science Center, Xi’an 710061
4. Department of Nephrology, No. 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong 723000, China
Publication Type:Journal Article
Keywords: end-stage renal disease (ESRD); cognitive function; uremic toxin; cystatin C; depression
From: Journal of Xi'an Jiaotong University(Medical Sciences) 2024;45(4):621-628
CountryChina
Language:Chinese
Abstract: 【Objective】 To explore the mediating role of depression between uremic toxins and cognitive function in end-stage renal disease (ESRD) patients, so as to provide a basis for early clinical intervention. 【Methods】 A retrospective study involved 49 predialysis ESRD patients diagnosed in the Nephrology Department of The First Affiliated Hospital of Xi’an Jiaotong University between August 2018 and October 2021, along with 50 healthy controls (HC). General information of the two groups was collected. Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test-Huashan Version (AVLT-H), Trail Making Test A (TMT-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to collect data on cognitive function, anxiety, and depression in both groups. Serological indicators in the ESRD group were used to clarify the impact of uremic toxins on cognitive function. PROCESS v3.4.1 was applied to explore the relationship between uremic toxins, depression, and cognitive function, as well as the mediating effect of depression. 【Results】 Significant differences were found between the ESRD group and the HC group in MoCA total score (P<0.001), AVLT-H (word learning; short-term delay; long-term delay,P<0.001; word recognition, P=0.001), TMT-A (P<0.001), BDI (P<0.001), and BAI (P=0.009). Cystatin C was a negative influencing factor for short-term delay in AVLT-H (B=-0.834, P=0.019), while BDI was a negative influencing factor for long-term delay in AVLT-H (B=-0.102, P=0.002), word recognition in AVLT-H (B=-0.071, P<0.001), and MoCA total score (B=-0.135, P=0.002). BDI partially mediated the effect of cystatin C on short-term delay in AVLT-H (total effect, c=-0.3346; direct effect, c′=-0.223 5; mediating effect, a×b=-0.111 0; and mediating effect proportion, 33.2%) and long-term delay in AVLT-H (total effect, c=-0.318 7; direct effect, c′=-0.218 8; mediating effect, a×b=-0.099 9; and mediating effect proportion, 31.3%). 【Conclusion】 ESRD patients experience cognitive decline as well as anxiety and depression. Cystatin C and depression are both negative influencing factors for cognitive decline in ESRD patients. Cystatin C indirectly affects cognitive function in ESRD patients through depression.