Abstract
Studies suggest that hemodialysis patients are at a higher risk for cognitive decline than healthy individuals; however, underlying mechanisms have not been fully elucidated. We aimed to investigate the roles of serum biomarkers, such as brain-derived neurotrophic factor (BDNF), inflammatory cytokines, fibroblast growth factor (FGF)-23 and its co-receptor α-klotho and platelet (PLT) count in mild cognitive decline (MCD) of patients undergoing hemodialysis in this prospective cohort study. Serum levels of BDNF, tumour necrosis factor (TNF)-α, interleukin (IL)-6 and the number of PLT were significantly altered in the MCD group compared with those in healthy controls (HCs) or those with normal cognitive function (NCF). Although serum α-klotho and FGF-23 levels were significantly altered in the MCD group, there were no statistical differences between the MCD and NCF groups. Serum BDNF levels and PLT counts were significantly correlated with cognitive test scores. Receiver operating characteristic (ROC) curves demonstrated that BDNF and PLT were potential biomarkers for improved MCD diagnosis in patients with hemodialysis. These findings suggest that hemodialysis-related MCD is associated with altered BDNF, TNF-α and IL-6 levels as well as PLT counts and that serum BDNF levels and PLT counts are potential biomarkers for hemodialysis-related MCD diagnosis.
Highlights
Chronic kidney disease (CKD) has increasingly become a global public health problem[1]
We found that Montreal Cognitive Assessment (MoCA) scores were significantly lower in the mild cognitive decline (MCD) group than in the healthy controls (HCs) and normal cognitive function (NCF) groups, whereas no significant differences were observed between the HC and NCF groups
Our analysis revealed that brain-derived neurotrophic factor (BDNF) and PLT count were independently correlated with the Mini-Mental State Examination (MMSE) score (Fig. 4A,F); other biomarkers including α-klotho, fibroblast growth factor (FGF)-23, tumour necrosis factor (TNF)- α and IL-6 did not correlate with the MMSE score (Fig 4B–E)
Summary
Chronic kidney disease (CKD) has increasingly become a global public health problem[1]. We found that some non-elderly patients with normal cognitive function (NCF) before hemodialysis developed mild cognitive decline (MCD) after several years of hemodialysis. A cross-sectional cohort study including 108 maintenance hemodialysis patients reported that approximately 25% of individuals were cognitively declined[11]. These findings highlight the striking deleterious effects of hemodialysis on cognitive function of patients. A clinical study by Drew et al.[14] included 263 hemodialysis patients indicated that serum fibroblast growth factor (FGF)-23 was highly associated with poor performance on a cognition test. We evaluated correlations between cognition test scores and serum biomarkers and performed receiving operating characteristic (ROC) curves to assess whether certain serum biomarkers could predict and diagnose hemodialysis-related MCD
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