Abstract
Patients with end-stage renal disease (ESRD) have an increased risk of both impaired cognitive function and peripheral artery disease (PAD) than the general population. The association between PAD and dementia is recognized, but there are limited studies in patients with ESRD. The aim of this study was to evaluate the relationship between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and cognitive impairment in patients receiving hemodialysis (HD). We enrolled 136 prevalent HD patients (mean age 59.3 ± 10.5 years, 55.9% male). Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI) by trained psychiatrists. Associations between the cognitive function and ABI and baPWV were assessed using multiple linear regression analysis. Compared with HD patients with ABI ≥ 0.9, patients with ABI < 0.9 had lower MoCA score (p = 0.027) and lower CASI score but did not achieve significant level (p = 0.056). In the multivariate stepwise linear regression analysis, ABI (per 0.1) was independently positively associated with the MoCA score (β coefficient = 0.62, p = 0.011) and the CASI score (β coefficient = 1.43, p = 0.026). There is a negative association between baPWV (per 100 cm/s) and CASI (β coefficient = −0.70, p = 0.009). In conclusion, a low ABI or high baPWV was associated with a lower cognitive function in HD patients.
Highlights
Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) have a higher risk of dementia than the general population [1, 2], and patients with both dementia and ESRD have been associated with disability, hospitalization, dialysis withdrawal, and mortality [3,4,5]
peripheral artery disease (PAD) has been associated with an increased risk of both cardiovascular disease [9] and cognitive dysfunction in the general population [10], and a low ankle-brachial index (ABI) has been reported to predict the future risk of cognitive impairment [11] and dementia [12]
PAD was assessed according to ABI and brachial-ankle pulse wave velocity (baPWV), and cognitive performance was assessed according to Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI), which collectively evaluated memory, orientation, attention, visual screening, motor speed, planning abilities, executive function, and language
Summary
Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) have a higher risk of dementia than the general population [1, 2], and patients with both dementia and ESRD have been associated with disability, hospitalization, dialysis withdrawal, and mortality [3,4,5]. Given the high prevalence of dementia in patients with ESRD, identifying clinical markers that can predict cognitive dysfunction may be beneficial for both prevention and reducing health care costs. Scuteri et al reported an association between arterial stiffness and brain injury and related brain pathologies [6] They concluded that increased central pulse pressure and Disease Markers wave reflections may influence both the brain and kidneys and that it is likely that these phenomena are emphasized in ESRD patients. PAD has been associated with an increased risk of both cardiovascular disease [9] and cognitive dysfunction in the general population [10], and a low ABI has been reported to predict the future risk of cognitive impairment [11] and dementia [12]
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