Prevalence and risk factors of cognitive impairment in patients receiving maintenance hemodialysis

Background

Cognitive impairment is common but understudied in patients with chronic kidney disease, especially in end-stage renal disease.

Aim

To study the prevalence, nature, and clinical and demographic risk factors for cognitive impairment in patients receiving maintenance hemodialysis.

Methods

A cross-sectional, multicenter study was conducted involving 260 patients aged 18 to 80 years receiving maintenance hemodialysis for six or more months. Cognitive function was assessed using the MoCA (Montreal Cognitive Assessment) and MMSE (Mini-Mental State Examination). Participants were divided into two groups: those with cognitive impairment and those with normal cognitive function. The association of cognitive impairment with main clinical and demographic parameters was studied using between-group comparisons and multivariate logistic regression analysis.

Results

The prevalence of cognitive impairment according to MoCA was 63.5% and 60.1% according to MMSE. The most common changes were detected in delayed memory, visuoconstructive and executive skills, orientation, attention, and speech. Age, presence of diabetes mellitus, higher systolic blood pressure, and elevated blood levels of C-reactive protein and parathyroid hormone were identified as significant independent predictors of cognitive impairment (MoCA 26 points) in patients on maintenance hemodialysis.

Conclusion

The results confirm the high prevalence of multimodal cognitive impairment in patients on maintenance hemodialysis and justify the need for regular cognitive screening. Timely detection of cognitive impairment and management of modifiable risk factors can help preserve cognitive function, improve quality of life, and prognosis in these patients.