Prelevic Vladimir, Radunovic Danilo, Antunovic Tanja, Ratkovic Marina, Gligorovic-Bahranovic Najdana, Gledovic Branka, Vujosevic Snezana, Nedovic-Vukovic Mirjana, Basic-Jukic Nikolina
Clinic for Nephrology, Clinical Center of Montenegro, Montenegro.
Center for Clinical-Laboratory Diagnostics, Clinical Center of Montenegro, Montenegro.
Ther Apher Dial. 2018 Apr;22(2):118-123. doi: 10.1111/1744-9987.12610. Epub 2017 Dec 7.
Prevalence of cognitive function decline in end stage renal disease (ESRD) patients undergoing hemodialysis is higher than in the general population. We analyzed risk factors for cognitive function decline in those patients. This study included 93 ESRD patients undergoing hemodialysis two or three times a week in three centers for hemodialysis in Montenegro. The cognitive status of patients was assessed using the mini mental score examination (MMSE) test. All 93 patients have been divided into three groups according to the results of MMSE. Patients in the first group had severe cognitive impairment and MMSE score below 17 (26.88%), patients in the second group with MMSE score 18-23 had moderate cognitive impairment (40.86%) and third group of patients have MMSE >24 and no cognitive impairment (32.26%). There were no significant differences between groups for gender, smoking habits and level of parathyroid hormone. Level of schooling was significantly different between groups of patients (P < 0.001). Laboratory markers observed in this study with significant differences between groups were: IGF 1, IGFBP 3, erythrocytes and hemoglobin (P < 0.001, P = 0.004, P < 0.001, P = 0.002, respectively). IGF 1 proved to be of great importance for evaluating cognitive status in our study. This marker was statistically different between groups (P < 0.001) and Tukey post hoc analysis showed significant differences between all three groups (first and second group P = 0.045, second and third group P = 0.015, first and third group P < 0.001). Our data suggest that IGF 1 can be considered as novel biomarker for assessment of cognitive functioning in CKD patients, which can be of huge clinical importance.
接受血液透析的终末期肾病（ESRD）患者认知功能下降的患病率高于普通人群。我们分析了这些患者认知功能下降的危险因素。本研究纳入了黑山三个血液透析中心的93例每周接受两次或三次血液透析的ESRD患者。使用简易精神状态检查表（MMSE）测试评估患者的认知状态。根据MMSE结果，将所有93例患者分为三组。第一组患者有严重认知障碍，MMSE评分低于17分（26.88%），第二组患者MMSE评分为18 - 23分，有中度认知障碍（40.86%），第三组患者MMSE>24分且无认知障碍（32.26%）。各组在性别、吸烟习惯和甲状旁腺激素水平方面无显著差异。患者组之间的受教育程度有显著差异（P<0.001）。本研究中观察到的各组间有显著差异的实验室指标为：胰岛素样生长因子1（IGF 1）、胰岛素样生长因子结合蛋白3（IGFBP 3）、红细胞和血红蛋白（分别为P<0.001、P = 0.004、P<0.001、P = 0.002）。在我们的研究中，IGF 1被证明对评估认知状态非常重要。该指标在各组之间有统计学差异（P<0.001），Tukey事后分析显示所有三组之间均有显著差异（第一组和第二组P = 0.045，第二组和第三组P = 0.015，第一组和第三组P<0.001）。我们的数据表明，IGF 1可被视为评估慢性肾脏病患者认知功能的新型生物标志物，这可能具有巨大的临床意义。
