A cross-sectional study on the characteristics of cognitive impairment in middle-aged and elderly patients undergoing maintenance hemodialysis
10.3760/cma.j.cn441217-20201118-00094
- VernacularTitle:中老年维持性血液透析患者认知功能损伤特征的横断面研究
- Author:
Yidan GUO
1
;
Chunxia ZHANG
;
Ru TIAN
;
Pengpeng YE
;
Guogang LI
;
Xin LI
;
Fangping LU
;
Yingchun MA
;
Yi SUN
;
Yuzhu WANG
;
Yuefei XIAO
;
Qimeng ZHANG
;
Haidan ZHAO
;
Xuefeng ZHAO
;
Yang LUO
Author Information
1. 首都医科大学附属北京世纪坛医院肾内科，北京 100038
- Keywords:
Renal dialysis;
Cognitive dysfunction;
Prevalence;
Risk factors
- From:
Chinese Journal of Nephrology
2021;37(8):632-638
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.
