Multivariate Analysis On Cognitive Impairment In Patients With End-stage Renal Disease Receiving Different Dialysis Methods

ObjectiveTo analyze the risk factors of cognitive impairment(CI)in patients with end-stage renal disease(ESRD)and receiving different dialysis methods.MethodsA total of 93 patients on maintenance hemodialysis(MHD)and 50 patients on peritoneal dialysis(PD)treated in the First Affiliated Hospital of Bengbu Medical College from November 2021 to April 2022 were recruited as the research subjects.According to the scores of montreal cognitive assessment(Mo CA),the patients were divided into CI group of MHD patients,non-CI group of MHD patients,CI group of PD patients,and non-CI group of PD patients.General clinical data and laboratory test results of all enrolled patients were collected,and data between the two groups were compared.Binary Logistic regression analysis was performed for those with statistically significant differences,so as to explore the risk factors for CI in MHD and PD patients.At the same time,the predictive value of age,platelet to lymphocyte ratio(PLR)and combined model for CI occurrence in patients with MHD and PD was analyzed by receiver operator characteristic(ROC).Results1.A total of 143 patients were enrolled in this study,70(48.95%)were males,and the mean age was 50.76±11.56 years old.A total of 75 patients had CI,with a prevalence rate of 52.45%.2.The prevalence rate of CI in MHD patients was 56.99%,and age,cystatin C,serum homocysteine(Hcy),neutrophil to lymphocyte ratio(NLR),PLR,C-reaction protein(CRP),hemoglobin,albumin(Alb),25-hydroxyvitamin-D,and duration of education ≥12 years were statistically significant differences between CI and non-CI group(P < 0.05).The prevalence rate of CI in PD patients was 44.00%,and there were statistically significant differences in age,NLR,PLR,CRP,hemoglobin,25-hydroxyvitamin D and gender between CI and non-CI group(P < 0.05).3.Binary Logistic regression analysis showed that age,PLR,cystatin C and Hcy were risk factors for CI in MHD patients(P < 0.05).Age,hemoglobin,PLR and 25-hydroxyvitamin-D were risk factors for CI in PD patients(P < 0.05).4.ROC curve analysis suggested that PLR,age and combined model predicted the area under the curve of CI in MHD patients were 0.714(95%CI: 0.611～ 0.817,P <0.001),0.723(95%CI: 0.620 ～ 0.826,P < 0.001)and 0.798(95%CI: 0.711 ～ 0.886,P <0.001);PLR,age and combined models predicted the area under the curve of CI in PD patients were 0.684(95%CI: 0.533 ～ 0.836,P=0.027),0.810(95%CI: 0.679 ～ 0.941,P< 0.001)and 0.849(95%CI: 0.736 ～ 0.962,P < 0.001).ConclusionThe incidence of CI in MHD and PD patients in our hospital is relatively high,especially the impairment of executive function,memory,attention and language function.Older age,higher PLR,higher cystatin C,and higher homocysteine are risk factors for CI in MHD patients.Older age,higher PLR,lower hemoglobin,and low 25-hydroxyvitamin-D levels are risk factors for CI in PD patients.Age,PLR and combined model have predictive value for CI in patients with MHD and PD.Moreover,the combined model has the highest predictive value for CI occurrence in patients with MHD and PD.