Correlation Between The Degree Of Hemodialysis Complicated With Cognitive Impairment And TCM Syndrome Types And Clinical Indicators

Purpose:To investigate the cognitive function of hemodialysis patients has changed or not,and to explore the relationship among the degree of cognitive impairment of hemodialysis patients,TCM syndrome types and laboratory indicators,which is in order to provide the basis for the follow-up TCM intervention,make medical staff can better manage hemodialysis patients and improve the quality of life of dialysis patients.Material and method:A cross-sectional study was conducted,recruiting outpatients with conventional hemodialysis in the blood purification center of the affiliated hospital of Liaoning University of Traditional Chinese Medicine from August 2020 to February 2021.General data,including name,gender,age,years of education,primary diseases,dialysis age and ultrafiltration volume,etc,was collected after the patients or their families knew the whole process of the test and signed the informed consents.Montreal cognitive assessment(Mo CA)and TCM syndrome differentiation scale of chronic kidney disease were used to obtain the patients'cognitive status and TCM syndrome types,which were evaluated twice with an interval of 6months.Laboratory measurements,including hemoglobin(Hb),parathyroid hormone(PTH),serum albumin(ALB),serum calcium(Ca),serum phosphorus(P),and carbon dioxide binding power(CO₂CP)were collected for the month of evaluation.SPSS22.0 software was used for statistical analysis to get the relationship among the degree of cognitive impairment in hemodialysis patients,TCM syndrome types and laboratory indicators.Results:1.Relationship between cognitive status of patients and general data:the cognitive status of hemodialysis patients was negatively correlated with age(P₁?P₂=0.000)and positively correlated with years of education(P₁=0.037,P₂=0.011),which is statistically significant(P<0.05).Gender(P₁=0.762,P₂=0.794),dialysis age(P₁=0.480,P₂=0.518),variety of primary diseases(P₁=0.639,P₂=0.358),and hyperfiltration on hemodialysis(P₁=0.190,P₂=0.423)were not correlated with cognitive status,which were not statistically significant(P>0.05).2.The relationship between cognitive status and laboratory indexes:the cognitive status of hemodialysis patients was affected by hemoglobin(P₁=0.039,P₂=0.018)and serum albumin(P₁=0.011,P₂=0.025).The concentration of hemoglobin and serum albumin were positively correlated with cognitive function status,which was statistically significant(P<0.05).Parathyroid hormone(P₁=0.818,P₂=0.719),serum calcium(P₁=0.466,P₂=0.253),serum phosphorus(P₁=0.060,P₂=0.880)and carbon dioxide binding capacity(P₁=0.742,P₂=0.586)had no correlation with cognitive function,which was not statistically significant(P>0.05).3.Multiple stepwise logistic regression analysis of all the collected data and Mo CA scores showed that age was an independent risk factor for cognitive function,which was statistically significant.(P<0.05)4.The results of two cognitive function evaluations showed that the functional decline of visuospatial and executive function,attention,abstraction,and delayed recall domains determined the impairment of overall cognitive function,which were statistically significant(P<0.05).Cognitive function status,declining within a half year period,showed decrements in global cognitive function and language,which was statistically significant(P<0.05).5.The relationship between cognitive function status and TCM syndrome types:for deficiency syndromes,the patients with normal cognitive function are mainly spleen kidney qi deficiency syndrome;the patients with mild cognitive impairment are mainly spleen kidney qi deficiency syndrome and qi and yin deficiency syndrome;the patients with moderate and severe cognitive impairment are mainly spleen kidney qi deficiency syndrome,liver-kidney yin deficiency syndrome and qi and yin deficiency syndrome,without other syndrome types,which was statistically significant(P₁=0.027,P₂=0.028).For empirical symptoms,the patients with normal cognitive function mainly have damp turbid syndrome and blood stasis syndrome,or with damp heat syndrome,or without concurrent syndrome;the patients with mild cognitive impairment mainly have damp turbid syndrome,damp heat syndrome,blood stasis syndrome or without concurrent syndrome;the patients with moderate and severe cognitive impairment mainly have damp turbid syndrome,damp heat syndrome and blood stasis syndrome,sometimes without accompanying syndrome.The difference was statistically significant(P₁=0.015,P₂=0.025).Conclusion:1.The incidence of combined cognitive impairment in hemodialysis patients reaches a higher morbidity between 77.4%to 79.2%,with blindness to this complication for most patients,requiring medical staff pays more attention to it.2.The cognitive status of hemodialysis patients was negatively correlated with age and positively correlated with the years of education and concentrations of hemoglobin and serum albumin;besides,age was an independent risk factor for cognitive impairment.3.The injury in the domains of visuospatial versus executive function,attention,abstraction,delayed recall in cognitive function determines the decline in general cognitive function.The decline can occur within a half year,with statistically significant reductions in general cognition function and the domain of language.4.The relationship between cognitive function status and TCM syndromes:in the aspect of deficiency syndromes,spleen-kidney qi deficiency syndrome accompanies the whole course of CI;with the aggravation of the cognition,it can be transformed into qi-yin deficiency syndrome,liver-kidney yin deficiency syndrome.In terms of concurrent syndrome,patients with spleen-kidney qi deficiency syndrome are accompanied by more concurrent syndromes,while ones with qi-yin deficiency syndrome and liver-kidney yin deficiency syndrome have fewer concurrent syndromes;damp turbidity syndrome and blood stasis syndrome are accompanied by the whole course of complications,and with the aggravation of the degree of obstacle,the patients'number of damp heat syndrome and blood stasis syndrome is gradually increasing.