Preliminary Study On Cognitive Function Related Risk Factors And Brain Function Imaging In Maintenance Hemodialysis

Objective:To investigate the incidence of mild cognitive impairment in patients undergoing maintenance hemodialysis in a single center;To study the influencing factors of cognitive function in patients with MHD,and to understand the changes of brain function imaging in patients with MHD in resting state by low-frequency amplitude analysis based on resting state fMRI.Methods:A total of 66 patients with ESRD treated by MHD in Nanchong Central Hospital from November 2019 to July 2020 were selected.The cognitive function of the patients was assessed by using the MOCA scale,among which the score≥26 was classified as normal cognitive function and the score among 18-26 was divided into MCI group.According to the score,all the patients were divided into two groups,namely mild cognitive impairment group and normal cognitive function group.Collect general information of all patients,such as age,sex,education level,dialysis age;At the same time,the patients’ complications,such as diabetes history,hypertension history,pre-dialysis systolic blood pressure and diastolic blood pressure were collected.Primary diseases leading to kidney damage should also be collected.Collection of laboratory test data:such as serum parathyroid hormone,serum albumin,serum calcium,serum phosphorus,serum creatinine,hemoglobin,serum uric acid,blood glucose.Univariate analysis was performed on general data and laboratory data to compare the differences of relevant factors between the two groups.Logistic regression analysis was performed on the relevant factors with differences in univariate analysis,so as to obtain the final influencing factors on cognitive function of MHD patient.At the same time,according to the voluntary principle and exclusion of MRI related contraindications,22 MCI patients were finally selected for head MRI examination.At the same time,27 healthy middle-aged and the old control subjects matched with the case group in age,gender and years of education were recruited for RS-fMRI examination.DTI,bold-fMRI,T1WI and T2WI sequences were collected by magnetic resonance instruments.The differences in resting state brain function imaging between MHD patients and healthy controls were determined by ALFF analysis.Results:1.The incidence of cognitive dysfunction in MHD patients is about 59.1%;2.Univariate analysis showed that there were differences in the incidence of cognitive dysfunction among groups of different ages,education levels,systolic blood pressure,hemoglobin and serum parathyroid hormone,and The difference was statistically significant(P<0.05);3.Logistic regression analysis showed that age(OR=4.629,95%CI:1.282-16.716)and serum parathyroid hormone(OR=4.545,95%CI:1.225-16.866)were the main factors affecting patients’ cognitive function;4.ALFF analysis results show that:Compared with the healthy middle-aged and the old people,the ALFF value of MCI patients increased in the following brain regions:Bilateral parhippocampal gyrus,left hippocampus,right inferior temporal gyrus,left inferior frontal gyrus orbital part,right inferior frontal gyrus(island capus,trigonum);The ALFF values in MCI patients were reduced in bilateral precuneus,left parietal lobe,bilateral middle temporal gyrus,left superior temporal gyrus,left middle frontal gyrus,left inferior frontal gyrus,and bilateral superior frontal gyrus,left middle occipital gyrus.Conclusion:1.The incidence of cognitive dysfunction in MHD patients is high;2.Old age and high level of serum parathyroid hormone may be risk factors for cognitive dysfunction in MHD patients;3.Patients with MHD associated with MCI showed decreased ALFF values in resting brain regions:bilateral precuneus,left parietal lobe,bilateral middle temporal gyrus,left superior temporal gyrus,left middle frontal gyrus,left inferior frontal gyrus,and bilateral superior frontal gyrus,left middle occipital gyrus;Brain regions with enhanced ALFF include:Bilateral parhippocampal gyrus,left hippocampus,right inferior temporal gyrus,left inferior frontal gyrus orbital part,right inferior frontal gyrus(island capus,trigonum).This study lays a foundation for further exploration of the neuropathological mechanism of MCI in MHD patients.