Risk Factors For Cognitive Dysfunction In Patients On Maintenance Hemodialysis And Their Association With AD7c-NTP In The Urine

Research background and purpose:Cognitive impairment(CI)is a complication found in recent years and with a high incidence in patients with maintenance hemodialysis(MHD).The study used the Montreal Cognitive Assessment(Mo CA)to measure patients’ cognitive function status and investigate which factors are risk factors for CI in patients with MHD.Patients with MHD with a urine output of ≥50 ml/24 hours and a morning urine ≥ 5 ml were screened to detect the concentration of Alzheimer’s associated neurofilament protein(AD7c-NTP)in the urine,and whether the occurrence of CI in MHD patients was related to AD7c-NTP in the urine,which provided a certain basis for early prevention and diagnosis of CI in patients with MHD.Materials and Methods:A total of 159 MHD patients who underwent dialysis treatment at the First Affiliated Hospital of Chengdu Medical College from July 2021 to September 2021 were selected,and the patients were divided into cognitive dysfunction(CI)group and normal cognitive(NC)group by Mo CA.General information of patients is obtained in the form of questionnaire surveys and medical records,and blood samples of patients are collected separately before dialysis and sent to the laboratory department for measurement.The incidence and damage of CI in MHD patients were studied;the general data and laboratory indicators of the two groups of patients were analyzed to study the risk factors for CI in MHD patients;the urine collection was carried out in patients with a urine volume of ≥50 ml/24 hour and the morning urine ≥ 5 ml,the concentration of AD7c-NTP in the urine was detected,and the diagnostic value of AD7c-NTP in the urine for the CI of MHD patients was discussed.Result:1.Among the 1.159 patients with MHD,105 cases(66.04%)had CI and 54 cases(33.96%)had NC.2.Compared with 54 MHD patients with NC,there were statistical differences in the damage of visual space and executive function(P<0.001),attention and computing ability(P<0.001),language ability(P=0.012),delayed recall(P<0.001),and abstract thinking field(P<0.001)compared with 54 patients with NC MHD.3.The results of multi-factor regression analysis show that age,hypertension,diabetes,serum albumin,and nutritional status are the main factors affecting cognitive function in patients with MHD.Among them,age(OR=1.189,95% CI: 1.097-1.289),hypertension(OR=4.469,95% CI: 1.170-17.067),diabetes mellitus(OR=4.798,95% CI:1.193-19.299)are risk factors for the development of CI in patients with MHD,and good nutritional status(OR=0.587,95% CI: 0.422-0.817),high albumin(OR=0.882,95% CI: 0.797-0.976)is a protective factor for cognitive function in patients with MHD.4.CI patients had significantly higher urine AD7c-NTP concentrations than NC(P=0.019).Conclusion:1.The proportion of CI in MHD patients is high,mainly manifested as multi-domain damage,of which visual space and executive function,attention and computing power,language,delayed recall,abstract thinking areas are seriously damaged.2.Increasing age,diabetes,and hypertension are risk factors for CI;good nutritional status and high albumin are protective factors for cognitive function.3.AD7c-NTP in the urine is a potential diagnostic marker for the development of CI in patients with MHD.