Relationship Between Serum Soluble Klotho Protein And Cognitive Function In Patients With End-stage Renal Disease

Objective:To investigate the relationgship between serum soluble Klotho（s Klotho）protein and other factors and cognitive function in patients with end-stage renal disease（ESRD）,compare the difference of cognitive function between predialysis ESRD patients and hemodialysis（HD）patients and evaluate the effect of HD on cognitive function.Methods:A total of 125 ESRD patients were selected from hospitalization and blood purification center in Hebei General Hospital from March 2020 to December 2020,among which 64 were predialysis ESRD patients（PRE group）and 61 were HD patients（HD group）.The general and laboratory data of the patients were collected,and the function was evaluated with the Chinese version of Montreal Cognitive Assessment scale（C-Mo CA）and the Chinese version of Mini Mental State examination scale（C-MMSE）.The effect of HD modality on cognitive function and the influencing factors of cognitive impairment（CI）in patients with ESRD were analyzed by Logistic regression,and the predictive value of s Klotho in ESRD-CI was evaluated by receiver operating characteristic（ROC）curve.Results:1 Comparison of baseline characteristics between HD group and PRE group:A total of 125 patients with ESRD were enrolled,with an average age of（55.70±13.71）years.There were 72 male patients（57.6%）and 53 female patients（42.4%）.The body mass index in the PRE group was significantly higher than that in the HD group（P=0.021）.The levels of high-sensitivity C-reactive protein,hemoglobin,albumin,alkaline phosphatase,serum calcium,serum phosphorus,serum magnesium,ferritin,25-hydroxy vitamin D,osteocalcin,intact parathyroid hormone and s Klotho in HD group were significantly higher than those in PRE group（P<0.05）,while the levels of serum natrium,total cholesterol and uric acid in HD group were significantly lower than those in PRE group（P<0.05）.2 Comparison of cognitive assessment between HD group and PRE group:The proportion of total CI with C-MMSE as evaluation tool was significantly lower than that with C-Mo CA（24.8%vs 48.8%）.3 Analysis of the impact of HD on cognitive function:The risk of developing CI in HD modality during C-MMSE assessment was 0.401times higher than that in predialysis ESRD patients,and the risk of developing CI in C-Mo CA assessment was 0.414 times higher than that in predialysis ESRD patients.After adjusting for age and sex,model 1 was established,and it was found that HD modality still showed better cognitive function than predialysis ESRD patients（C-MMSE,OR=0.395,95%confidence interval（CI）0.157～0.997,P=0.049;C-Mo CA,OR=0.391,95%CI 0.179～0.856,P=0.019）.Model 2 was established based on model 1after adjusting for education level,work status,albumin,diabetes and stroke history.It was found that HD modality was not an independent protective factor of CI（C-MMSE,P=0.188;C-Mo CA,P=0.151）.4 Analysis of influencing factors of CI in 125 patients with ESRD:Logistic regression analysis showed that age（per one-year increased,OR=1.066,95%CI 1.005～1.132,P=0.034）and stroke history（OR=5.446,95%CI 1.457～20.508,P=0.012）were independent risk factors for CI,while s Klotho(per 1pg·ml^-1increased,OR=0.989,95%CI 0.979～0.999,P=0.032)was a protective factor for CI when assessed by C-MMSE.Age（per one-year increased,OR=1.051,95%CI 1.004～1.009,P=0.034）was an independent risk factor for CI,while high education level（7-11years vs≤6years,OR=0.102,95%CI 0.025～0.412,P=0.001;≥12years vs≤6years,OR=0.051,95%CI 0.011～0.247,P=0.000）and s Klotho(per 1pg·ml^-1increased,OR=0.982,95%CI 0.972～0.992,P=0.001)were protective factors for CI when assessed by C-MOCA.5 ROC curve analysis of serum s Klotho protein for predicting ESRD-CI:The areas under the curve（AUC）for predicting ESRD-CI by serum s Klotho protein were（C-MMSE0.757）and（C-Mo CA0.804）respectively.The AUC of serum s Klotho protein for predicting PRE-CI were（C-MMSE0.675）and（C-Mo CA0.647）respectively.The AUC of serum s Klotho protein for predicting HD-CI were（C-MMSE0.824）and（C-Mo CA0.925）respectively.Conclusion:1 ESRD-CI is very common.The prevalence rate of CI in predialysis ESRD patients is higher than that of HD patients.HD is not an independent influencing factor of CI.C-Mo CA may be more suitable for rapid screening of CI than C-MMSE.2 The increasing of age,low education level,history of stroke and decreasing of s Klotho are associated with the worse cognitive function of patients with ESRD.s Klotho may be a protective factor of the onset of ESRD-CI,which may be an effective index to predict ESRD-CI.