Abstract
Objective To investigate the relationship between body cell mass index (BCMI) and cognitive impairment in maintaining hemodialysis (MHD) patients. Methods We collected the general materials, laboratory indexes, and physical measurement indexes of patients undergoing maintenance hemodialysis in hemodialysis centers of 20 tertiary and tertiary general hospitals in Guizhou Province from June to September 2020. The body composition was measured by bioelectrical impedance method, and the BCMI value was calculated. The subjects were divided into normal cognitive function group (score ≥27), mild cognitive impairment group (score 23–26), and severe cognitive impairment group (score <23). Two groups of people with normal cognitive function and cognitive impairment with similar baseline data (gender, age, and education) were obtained by propensity score matching (PSM). Results A total of 2008 subjects were included in this study, including 467 cases (23.3%) in the cognitive impairment group. A total of 814 cases were accurately matched after PSM. Multivariate logistic regression analysis showed that the incidence risk of the BCMI Q1 group was 8.99 times higher than that of the Q4 group (95% CI: 5.74 ∼ 14.09, P < 0.001). ROC curve analysis showed that the best threshold of BCMI for predicting cognitive impairment in MHD patients was 9.05, the sensitivity and specificity were 71.5% and 62.7%, respectively, and the area under the curve was 0.713 (95% CI: 0.678 ∼ 0.748, P < 0.001). Conclusions BCMI is related to cognitive impairment in MHD patients and has predictive value for the onset of cognitive impairment in MHD patients.
Highlights
Cognitive impairment (CI) refers to the defects of one or more key brain functions such as learning, memory, complex attention, executive function, language, perceptual motor function, and its severity can range from mild cognitive impairment (MCI) to severe dementia [1]
A total of 2008 maintenance hemodialysis (MHD) patients were included in this study, including 1145 males (57%) and 863 females (43%), aged (53.8 ± 14.7) years, 467 patients with cognitive impairment, with a morbidity rate of 23.3%. e sickness rate of each age segment was 9.9%, 32.8%, 39.6%, and 50.6% respectively. e morbidity rate of cognitive impairment increased with age, and the sickness rate of severe cognitive impairment increased with age (Figure 1)
Studies have shown that chronic kidney disease (CKD) is an independent risk factor for cognitive dysfunction, and its impact on cognitive impairment has exceeded genetic factors, and morbidity rate is higher in maintenance hemodialysis (MHD) patients [28]
Summary
Cognitive impairment (CI) refers to the defects of one or more key brain functions such as learning, memory, complex attention, executive function, language, perceptual motor function, and its severity can range from mild cognitive impairment (MCI) to severe dementia [1]. Malnutrition is common in patients of maintenance hemodialysis (MHD), featuring decreased protein and energy reserves and decreased muscle mass. Studies have found that malnutrition is an important factor bringing about brain function and neurodegenerative diseases [8–12] and is closely related to the occurrence and development of cognitive dysfunction. It impacts on cognitive function in the following ways: malnutrition leads to the shortage of important micronutrients like vitamins and essential fatty acids, which is likely to stimulate the inflammation to appear in the body, and the increase in inflammatory factors and oxidative stress leads to neuroinflammation and cerebrovascular damage [8, 13]. Besides energy and hormone metabolism change, and the levels of hormones related to cognitive function, like leptin, are reduced in malnourished patients [15, 16], accompanying with the decreased muscle masses that are related to the reduced volume of prefrontal, cingulate, occipitotemporal, and cerebellar gray matter [15–18]
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