COGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA (COGNI-HD STUDY)

Introduction:

Cognitive impairment (CI) is common in hemodialysis (HD) patients and prevalence is estimated to be 30-60%. In normal aging, the most affected domains are memory and executive dysfunction. Studies showed that HD patients had lower cognitive test scores in all domains predominantly in orientation and attention. Chronic kidney disease (CKD) -induced neuro-inflammation has been proposed as a critical mechanism responsible for neurological dysfunction. Mild cognitive impairment (MCI) is defined as The Montreal Cognitive Assessment (MoCA) scores of < 26, or < 21 in dexterity impairment and <18 in visual impairment. A cut-off score of 26 and 21 showed excellent sensitivity of 94% and 90% in detecting MCI and dementia respectively.

Methods:

Patients ≥ 18 years with written informed consent were enrolled prospectively from our HD unit with dialysis vintage of 3 months or more after exclusion of Delirium using the Short Confusion assessment method (CAM) test. Clinical data were collected from history and all biochemical and hematological assays as a part of routine follow-up in the HD unit. All patients underwent MoCA test which is a one-page 30-point screening test administered 10 minutes before the initiation of HD. In HD patients MoCA < 25 is suggestive of CI as per the current available literature.

Results:

122 patients were enrolled in the study. Mean (SD) age was 49.3 (16.2) years. 87(71.3%) were males. In terms of education, 64 (52.5%) HD patients were graduates, 2(1.6%) were illiterates and the remaining 56(45.9%) attended minimum of secondary level. Occupationally, 34 (28%) patients were involved in professional work, 38(31%) were unskilled workers and 50(41%) were unemployed. 50 (41%) patients had Type 2 diabetes mellitus with mean(SD) duration of 17(7) years, 76(62%) patients had hypertension with mean (SD) duration of 12(9.36) years. Mean (SD) serum calcium, serum albumin, phosphorous, intact PTH levels were 8.73(0.70), 4.05 (0.47), 4.79 (1.35) and 462(419). Single HD Kt/v mean value was 1.44 with mean Urea reduction ratio (URR) being 66.6%.

The mean (SD) MoCA in our cohort was 25.4(±3.64) and minimum value of 13 and maximum being 30. Different domains of MoCA are shown in Table 1.

The univariate analysis using linear regression correlation showed significant correlation of MoCA scores with age (p < 0.001), employment status (p<0.002), education (p < 0.001), serum albumin (p = 0.038) and Diabetes Mellitus (p = 0.017). On multivariate analysis, no significant correlation was found between MoCA and other variables.

Conclusions:

Cognitive impairment is more common in HD patients. Serum albumin level, age, education, employment status and diabetes mellitus can influence cognition. As per our cohort analysis, cognition was intact in most of our HD patients. Periodic assessment with MOCA score and identifying patients with cognitive impairment early would improve quality of life in hemodialysis recipients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.