The Correlation Study Of Protein-bound Toxins And Syndromes In Non-dialysis CKD Patients With Cognitive Impairment

Research Background:Chronic kidney disease(CKD)is a global public health problem.It is a slow progression process from slow decline of renal function to end-stage renal disease.In recent years,a large number of studies have focused on CKD with cognitive impairment(CI).It has been found that the incidence of cognitive impairment in CKD population is much higher than that in healthy population,and cognitive impairment has appeared in the early stage of CKD.CI not only predicts a higher mortality rate,but also affects patients'compliance,decision-making in the treatment process and daily careObjectives:(1)Statistical analysis of the prevalence of CI in CKD population before dialysis.distribution of TCM syndromes in CKD and CKD-CI patients;(2)To analyze the correlation between uremic toxins and CI by measuring the levels of uremic toxins in the study population.including total serum IS,pCS,free IS and pCS;(3)To analyze the correlation between cog.nitive impairment and general situation and clinical indicatorsMethods:Through cross-sectional study,clinical data.TCM syndromes,tongue and vein,Montreal Cognitive Assessment Scale(MoCA)and serum samples were collected from 139 CKD patients who met the inclusion criteria,and 14 healthy persons were included as control group.The total and free concentrations of IS and PCS in serum of CKD patients and control group were detected by high performance liquid chromatography-fluorescence method Patients with cognitive impairment(MoCA score<26)were divided into cognitive impairment group and cognitive normal group.Four diagnostic information of traditional Chinese medicine(TCM)were recorded and TCM symptom scoring table was filled in.General information.clinical indicators,smoking history,drinking history and past history of hypertension,diabetes.hyperlipidemia and stroke were collected.SPSS20.0 was used for data analysis,and t-test was used for comparison of quantitative data in accordance with normal distribution between the two groups;non-parametric test was used for skewed quantitative data,counting data and grade data;Pearson or Spearman test was used for correlation study of the same individual,P<0.05 was defined as significant difference,and further regression analysis was conducted for relevant samples.Results:(1)The study finally analyzed 139 patients,62 patients with MoCA score<26,and the incidence of cognitive impairment was 44.6%.(2)The first three symptoms of 139 patients were fatigue(71.22%),long nocturnal urine(66.91%)and dark lips(64.75%).The frequency of syndromes was Qi and blood deficiency(57%),stasis obstruction of brain collaterals(50%),dampness and turbidity hazard clearance(37%)and kidney essence deficiency(32%).(3)Comparing the distribution of syndromes between cognitive impairment and normal cognitive groups,40 cases(64.52%)of deficiency of Qi and blood,39 cases(50.65%)of vs,33 cases(53.23%)of obstruction of brain collaterals,36 cases(46.75%)of vs,26 cases(41.94%)of dampness and turbidity,26 cases(33.77%)of vs,16 cases(25.81%)of deficiency of kidney essence and 28 cases(36.36%)of vs were examined by chi-square test.X2=2.667,P=0.615,respectively.There was no significant difference.There were significant differences in MoCA scores between the two groups(Z=-1.999,p=0.046),MoCA scores of Qi and Blood Deficiency Syndrome(24.65±4.154)were significantly lower than those of non-Qi and Blood Deficiency Syndrome(25.93±3.782),and there were significant differences in language function between the two groups(Z=2.108,p=0.035),and language scores of Qi and Blood Deficiency Syndrome(2.56±0.655)were significantly lower than those of non-Qi and Blood Deficiency Syndrome(2.73 ±0.607).(4)59 cases(42%)had impaired visual space and executive function,7 cases(5%)had impaired naming function,28 cases(20%)had impaired attention function,10 cases(7%)had impaired language function,11 cases(8%)had impaired Abstract function,86 cases(62%)had impaired delayed recall function,and 8 cases(6%)had impaired orientation function.Among CKD patients,delayed recall was the most prominent cognitive impairment,followed by visual space and executive ability,attention,abstraction ability,language ability,orientation and naming ability.(5)History of hypertension(X2=4.941,p=0.026),age(t=-2.74,p=0.007),years of education(Z=-4.08,p<0.001),erythrocyte count(t=2.36,p=0.02),hemoglobin(t=3.148,p=0.002),calcium(t=2.28,p=0.024)were significantly different between cognitive impairment and normal cognitive group.The cognitive impairment group was older,had shorter education years,and had lower erythrocyte count,hemoglobin and blood calcium.Low education level is an independent risk factor for CKD-CI(p=0.001,95%CI0.972-1.006).(6)There was a significant negative correlation between PCS free concentration and naming function score(P=-0.28,p=0.032).The higher the PCS free concentration,the lower the naming function score.There was a significant negative correlation between PCS free concentration and language function score(P=-0.186,p=0.046).The higher the PCS total concentration,the lower the language function score.(7)Total concentration of IS(P =0.276,P=0.001)and free concentration of IS(P =0.371,P<0.001)were positively correlated with the integral of Qi and Blood De:ficiency Syndrome,and the free concentration of IS(P=0.238,P=0.008)was positively correlated with the integral of blood stasis obstructing brain collaterals syndrome.(8)The total concentration of IS(R2=0.575),the free concentration of IS(R2=0.55),the total concentration of PCS(R2=0.174)and the free concentration of PCS(R2=0.267)were positively correlated with the power index of eGFR in 139 subjects,and the correlation between IS and eGFR was more significant than that of PCS.(9)In 139 subjects,the scores of Qi and Blood Deficiency Syndrome were positively correlated with age,systolic pressure,creatinine,urea nitrogen,blood potassium,blood phosphorus,and negatively correlated with eGFR,erythrocyte count,hemoglobin,albumin and blood calcium.Brain collaterals blocked by blood stasis were positively correlated with age,creatinine,urea nitrogen,blood potassium,blood phosphorus,and negatively correlated with eGFR,erythrocyte count and hemoglobin.The scores of clearing syndrome of dampness and turbidity were positively correlated with BMI and systolic blood pressure,and negatively correlated with blood calcium,albumin,red blood cell count and hemoglobin.The integral systolic blood pressure of kidney essence deficiency syndrome was positively correlated with eGFR,but negatively correlated with eGFR.The scores of blood stasis syndrome were positively correlated with age,creatinine,urea nitrogen,phosphorus and potassium,and negatively correlated with hemoglobin,eGFR and erythrocyte count.Conclusion:(1)The incidence of cognitive impairment in patients with CKD is higher,about 44.6%,among which delayed memory impairment is the most prominent.(2)Age,low education level and anemia may be risk factors for CKD-CI.Low education level is an independent risk factor for CKD-CI(3)The free concentration of PCS was negatively correlated with the naming function score,while the total concentration of PCS was negatively correlated with the linguistic function score.(4)The distribution of syndromes in CKD-CI population was Qi-blood deficiency syndrome>blood stasis and brain collaterals syndrome>dampness and turbidity hazard clearance syndrome>kidney essence deficiency syndrome,and MoCA score and language function score of Qi-blood deficiency syndrome were lower.