Association between prognostic nutritional index and cognitive impairment in maintenance hemodialysis patients
10.3760/cma.j.cn441217-20230308-00315
- VernacularTitle:预后营养指数与维持性血液透析患者认知损害的相关关系
- Author:
Yanzhe PENG
1
;
Dan SHUAI
;
Chaomin ZHOU
;
Jing YUAN
;
Yan ZHA
Author Information
1. 贵州省人民医院肾内科，贵阳 550002
- Keywords:
Nutritional assessment;
Renal dialysis;
Cognitive dysfunction
- From:
Chinese Journal of Nephrology
2023;39(9):673-679
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the relationship between prognostic nutritional index (PNI) and cognitive impairment (CI) in maintenance hemodialysis (MHD) patients.Methods:It was a multicenter cross-sectional study that included adult patients who received MHD treatment at 18 hemodialysis centers in Guizhou province from June to October 2020 as the study subjects. Cognitive function was assessed with the mini-mental state examination score. According to the scale score, the patients were divided into CI group (≤27 scores) and non-CI group (>27 scores), and the differences between the two groups were compared. The patients were divided into Q1 (PNI<38.0), Q2 (38.0≤PNI<40.4), Q3 (40.4≤PNI<43.0), and Q4 (PNI≥43.0) groups based on the PNI quartiles. The PNI was estimated based on the serum albumin and lymphocyte count. Multivariate logistic regression analysis was used to analyze the correlation between PNI and CI, and subgroup analysis was conducted.Results:A total of 1 740 MHD patients were enrolled in the study, with 1 021 males (62.9%) and 719 females (37.1%). The age was (55±15) years old. There were 411 patients (23.6%) with CI. The age, C-reactive protein, and the proportions of females, current smoking/drinking and diabetes in the CI group were significantly higher than those in the non-CI group, and the education level, blood lymphocyte count, blood prealbumin, serum albumin, serum creatinine, blood uric acid and PNI were significantly lower than those in the non-CI group (all P<0.05). The risk of CI in Q1 group was 1.88 times higher than that of Q4 group after adjusting for confounding factors such as sex, age, body mass index, education level, comorbidities, current smoking/drinking, dialysis age and C-reactive protein ( OR=1.88, 95% CI 1.17-2.30, P=0.008). Subgroup analysis showed that there was an interaction between age and PNI on CI ( P=0.040 for interaction). Q1 group in the patients aged 18 to 45 years old had a higher risk of CI compared to Q4 group ( OR=3.30, 95% CI 1.19-9.10). Conclusions:Low PNI significantly increases the risk of CI in MHD patients, in particularly in the patients aged <45 years old.
