logo logo
Indole-3-acetic acid correlates with monocyte-to-high-density lipoprotein (HDL) ratio (MHR) in chronic kidney disease patients. International urology and nephrology PURPOSE:Indole-3-acetic acid is a protein-bound indolic uremic toxin deriving from tryptophan metabolism. Increased levels are associated with higher thrombotic risk and both cardiovascular and all-cause mortality. An emerging biomarker of cardiovascular disease is the monocyte-to-high-density lipoprotein ratio (MHR). The main purpose of this study was to investigate the association of indole-3-acetic acid with MHR and other markers of cardiovascular risk in patients with chronic kidney disease (CKD). METHODS:We enrolled 61 non-dialysis CKD patients and 6 dialysis patients. Indole-3-acetic acid levels were measured with ELISA technique. RESULTS:In the whole cohort of 67 patients, indole-3-acetic acid was directly related to Ca × P (ρ = 0.256; P = 0.0365) and MHR (ρ = 0.321; P = 0.0082). In the 40 patients with previous cardiovascular events, indole-3-acetic acid correlated with uric acid (r = 0.3952; P = 0.0116) and MHR (ρ = 0.380; P = 0.0157). MHR was related with fibrinogen (ρ = 0.426; P = 0.0010), arterial hypertension (ρ = 0.274; P = 0.0251), C-reactive protein (ρ = 0.332; P = 0.0061), gender (ρ = - 0.375; P = 0.0017; 0 = male, 1 = female), and CKD stage (ρ = 0.260; P = 0.0337). A multiple regression analysis suggested that indole-3-acetic acid might be an independent predictor of MHR. CONCLUSION:This study shows a significant association between indole-3-acetic acid and MHR. Prospective studies are required to evaluate if decreasing indole-3-acetic acid concentrations may reduce MHR levels and cardiovascular events and improve clinical outcomes. 10.1007/s11255-022-03137-0
Aberrant brain gray matter and functional networks topology in end stage renal disease patients undergoing maintenance hemodialysis with cognitive impairment. Frontiers in neuroscience Purpose:To characterize the topological properties of gray matter (GM) and functional networks in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis to provide insights into the underlying mechanisms of cognitive impairment. Materials and methods:In total, 45 patients and 37 healthy controls were prospectively enrolled in this study. All subjects completed resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion kurtosis imaging (DKI) examinations and a Montreal cognitive assessment scale (MoCA) test. Differences in the properties of GM and functional networks were analyzed, and the relationship between brain properties and MoCA scores was assessed. Cognitive function was predicted based on functional networks by applying the least squares support vector regression machine (LSSVRM) and the whale optimization algorithm (WOA). Results:We observed disrupted topological organizations of both functional and GM networks in ESRD patients, as indicated by significantly decreased global measures. Specifically, ESRD patients had impaired nodal efficiency and degree centrality, predominantly within the default mode network, limbic system, frontal lobe, temporal lobe, and occipital lobe. Interestingly, the involved regions were distributed laterally. Furthermore, the MoCA scores significantly correlated with decreased standardized clustering coefficient (γ), standardized characteristic path length (λ), and nodal efficiency of the right insula and the right superior temporal gyrus. Finally, optimized LSSVRM could predict the cognitive scores of ESRD patients with great accuracy. Conclusion:Disruption of brain networks may account for the progression of cognitive dysfunction in ESRD patients. Implementation of prediction models based on neuroimaging metrics may provide more objective information to promote early diagnosis and intervention. 10.3389/fnins.2022.967760
Risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients: A systematic review and meta-analysis of observational studies. Journal of advanced nursing AIMS:To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies. DESIGN:Systematic review and meta-analysis about observational studies. DATA SOURCES:Systematic search of seven databases, including PubMed, Web of Science, Scope, Wanfang Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Weipu Chinese Science and Technology Journal Database, from inception until October 2021. REVIEW METHODS:Observational studies reporting the risk factors for cognitive impairment in maintenance haemodialysis patients in English and Chinese language were included. Meta-analysis was performed to identify risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients with STATA 15.0 software. RESULTS:Overall, 37 eligible studies encompassing 129,849 cases were included. The risk factors with statistical significance after meta-analysis were older age, female sex, fewer years of education, hypertension, diabetes, cerebrovascular accident, multiple comorbid conditions, systolic blood pressure variability, arterial stiffness and low haemoglobin and albumin level. The overall prevalence of cognitive impairment in maintenance haemodialysis patients was 49.1%. CONCLUSION:The current analysis indicated a high prevalence of cognitive impairment in maintenance haemodialysis patients. Eleven risk factors for cognitive impairment in maintenance haemodialysis patients were identified, among which more attention should be paid to modifiable factors such as cardiovascular disease risk factors and specific kidney and dialysis-related factors. IMPACT:This paper provides an updated estimate of the pooled prevalence of cognitive impairment in maintenance haemodialysis patients. Identification of risk factors associated with cognitive impairment may assist in developing targeted prevention strategies for maintenance haemodialysis patients at high risk. NO PATIENT OR PUBLIC CONTRIBUTION:This study was a systematic review completed by the authors in accordance with relevant guidelines and processes and did not include the participation of patients, service users, caregivers or the general public. 10.1111/jan.15746
The Incidence Prognosis and Risk Factors of Cognitive Impairment in Maintenance Haemodialysis Patients. Lu Renhua,Xu Chenqi,Li Yan,Yu Ling,Shao Xinghua,Xie Kewei,Gu Jiaqi,Yu Zanzhe,Yan Yucheng,Guan Yangtai,Ni Zhaohui,Ronco Claudio,Gu Leyi Blood purification OBJECTIVE:To investigate the incidence and the prognosis of cognitive impairment (CI) and to find out the risk factors associated with the outcome in maintenance haemodialysis (MHD) patients. METHODS:Enrolled the patients who met the criteria as below: MHD (≥3 months) patients before July 2014, ≥18 years old and could carry on the cognitive function test (Montreal Cognitive Assessment [MoCA]). All enrolled patients were divided into 2 groups: CI group (MoCA < 26) and non-CI group (MoCA ≥26). All patients were followed up for 36 months. The incidence, demography data, medical history, haemodialysis data, laboratory examination and prognosis of CI in haemodialysis patients were prospectively compared and analyzed. Multivariate logistic regression analysis was used to investigate the risk factors of CI. Kaplan-Meier survival curve was used for survival analysis. RESULTS:In the present study, 219 patients were enrolled. The ratio of male to female was 1.46: 1. Age was 60.07 ± 12.44 and dialysis vintage was 100.79 ± 70.23 months. One hundred thirteen patients' MoCA scores were lower than 26 were divided into CI group. Education status (OR 3.428), post-dialysis diastolic pressure (OR 2.234) and spKt/V (OR 1.982) were independent risk factors for CI in MHD patients. During the follow-up period, 15 patients died (13.2%) in the CI group and 5 died (4.72%) in the non-CI group (p < 0.05). The Kaplan-Meier survival curve analysis showed that the survival rate of patients with CI was lower than that of non-CI group in MHD patients during 3 years follow-up (p = 0.046). CONCLUSION:CI is one of the most common complications in MHD patients. The mortality is high in patients who had CI. Education status, post-dialysis diastolic pressure and spKt/V are independent risk factors for CI in MHD patients. 10.1159/000493524
Cognitive Impairment in Maintenance Haemodialysis Patients: Early Identification and Management. Journal of advanced nursing 10.1111/jan.16494
Cognitive function and all-cause mortality in maintenance hemodialysis patients. Drew David A,Weiner Daniel E,Tighiouart Hocine,Scott Tammy,Lou Kristina,Kantor Amy,Fan Li,Strom James A,Singh Ajay K,Sarnak Mark J American journal of kidney diseases : the official journal of the National Kidney Foundation BACKGROUND:Cognitive impairment is common in hemodialysis patients and is associated with significant morbidity. Limited information exists about whether cognitive impairment is associated with survival and whether the type of cognitive impairment is important. STUDY DESIGN:Longitudinal cohort. SETTING & PARTICIPANTS:Cognitive function was assessed at baseline and yearly using a comprehensive battery of cognitive tests in 292 prevalent hemodialysis patients. PREDICTOR:Using principal component analysis, individual test results were reduced into 2 domain scores, representing memory and executive function. By definition, each score carried a mean of 0 and SD of 1. OUTCOMES:Association of each score with all-cause mortality was assessed using Cox proportional hazards models adjusted for demographics and dialysis and cardiovascular (CV) risk factors. RESULTS:Mean age of participants was 63 years, 53% were men, 23% were African American, and 90% had at least a high school education. During a median follow-up of 2.1 (IQR, 1.1-3.7) years, 145 deaths occurred. Each 1-SD better executive function score was associated with a 35% lower hazard of mortality (HR, 0.65; 95% CI, 0.55-0.76). In models adjusting for demographics and dialysis-related factors, this relationship was partially attenuated but remained significant (HR, 0.81; 95% CI, 0.67-0.98), whereas adjustment for CV disease and heart failure resulted in further attenuation (HR, 0.87; 95% CI, 0.72-1.06). Use of time-dependent models showed a similar unadjusted association (HR, 0.62; 95% CI, 0.54-0.72), with the relationship remaining significant after adjustment for demographics and dialysis and CV risk factors (HR, 0.79; 95% CI, 0.66-0.94). Better memory was associated with lower mortality in univariate analysis (HR per 1 SD, 0.82; 95% CI, 0.69-0.96), but not when adjusting for demographics (HR, 1.00; 95% CI, 0.83-1.19). LIMITATIONS:Patients with dementia were excluded from the full battery, perhaps underestimating the strength of the association. CONCLUSIONS:Worse executive function and memory are associated with increased risk of mortality. For memory, this association is explained by patient demographics, whereas for executive function, this relationship may be explained in part by CV disease burden. 10.1053/j.ajkd.2014.07.009
Evaluation of Screening Tests for Cognitive Impairment in Patients Receiving Maintenance Hemodialysis. Drew David A,Tighiouart Hocine,Rollins Jasmine,Duncan Sarah,Babroudi Seda,Scott Tammy,Weiner Daniel E,Sarnak Mark J Journal of the American Society of Nephrology : JASN BACKGROUND:Neurocognitive testing shows that cognitive impairment is common among patients receiving maintenance hemodialysis. Identification of a well performing screening test for cognitive impairment might allow for broader assessment in dialysis facilities and thus optimal delivery of education and medical management. METHODS:From 2015 to 2018, in a cohort of 150 patients on hemodialysis, we performed a set of comprehensive neurocognitive tests that included the cognitive domains of memory, attention, and executive function to classify whether participants had normal cognitive function versus mild, moderate, or severe cognitive impairment. Using area-under-the-curve (AUC) analysis, we then examined the predictive ability of the Mini Mental State Examination, the Modified Mini Mental State Examination, the Montreal Cognitive Assessment, the Trail Making Test Part B, the Mini-Cog test, and the Digit Symbol Substitution Test, determining each test's performance for identifying severe cognitive impairment. RESULTS:Mean age was 64 years; 61% were men, 39% were black, and 94% had at least a high-school education. Of the 150 participants, 21% had normal cognitive function, 17% had mild cognitive impairment, 33% had moderate impairment, and 29% had severe impairment. The Montreal Cognitive Assessment had the highest overall predictive ability for severe cognitive impairment (AUC, 0.81); a score of ≤21 had a sensitivity of 86% and specificity of 55% for severe impairment, with a negative predictive value of 91%. The Trails B and Digit Symbol tests also performed reasonably well (AUCs, 0.73 and 0.78, respectively). The other tests had lower predictive performances. CONCLUSIONS:The Montreal Cognitive Assessment, a widely available and brief cognitive screening tool, showed high sensitivity and moderate specificity in detecting severe cognitive impairment in patients on maintenance hemodialysis. 10.1681/ASN.2019100988
Mild cognitive impairment in maintenance hemodialysis patients: a cross-sectional survey and cohort study. Pei Xiaohua,Lai Shuyuan,He Xianglan,Masembe Nakimera Pearl,Yuan Haichuan,Yong Zhenzhu,Zhu Bei,Wu Jianqing,Zhao Weihong Clinical interventions in aging INTRODUCTION:Few studies focused on mild cognitive impairment (MCI) in maintenance hemodialysis (MHD) patients. This study was conducted to survey the prevalence, the potent risk factors of MCI in MHD patients, and further observe the progress of MCI in a period of 6 months. METHODOLOGY:Mini-Mental State Examination, and Montreal Cognitive Assessment were used to assess cognitive condition. MHD patients were enrolled from The First Affiliated Hospital of Nanjing Medical University, who had a stable hemodialysis history for more than 3 months. RESULTS:Sixty-four MHD patients and 54 general subjects were finally included. The average age of both groups was more than 60 years. The prevalence of MCI in the MHD group was significantly higher than that in general population (60.9% vs 29.6%, <0.05). Spearman correlation analysis indicated that MCI was related to age, comorbidities, education years, uric acid, serum albumin, and blood pressure. The prevalence and severity of MCI in the MHD group remained unchanged during the 6 months (prevalence: 59.5%-66.6%, MoCA scores: 22.9-22.5). CONCLUSION:MHD patients sustain a fairly high prevalence of MCI. Multiple risk factors influence the incidence and progression of MCI in MHD patients. More attention should be paid to this special population. 10.2147/CIA.S178854