Cui Lei, Chen Weixia, Yu Xingxing, Ju Changping
Medical School, Southeast University, Nanjing, Jiangsu, China.
Nursing Department, Zhongda Hospital, Nanjing, Jiangsu, China.
Int J Nurs Sci. 2019 Dec 11;7(1):60-65. doi: 10.1016/j.ijnss.2019.12.003. eCollection 2020 Jan 10.
Patients undergoing maintenance hemodialysis (MHD) have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population, and those with cognitive impairment are at higher risk of death than those without cognitive impairment. Having diabetes has been associated with an increased risk of cognitive decline in end-stage kidney disease patients treated with peritoneal dialysis or kidney transplant. However, these findings may not extend to the hemodialysis population. Thus, we aim to investigate the relationship between having diabetes and cognitive function in MHD patients.
This was a cross-sectional study. A total of 203 patients treated with MHD from two blood purification centers were enrolled as subjects. The Chinese version of the Montreal Cognitive Assessment (MoCA) was utilized to assess cognitive function.
MHD patients with diabetes had a significantly higher prevalence of global cognitive impairment and inferior performance in global cognition, visuospatial/executive function, naming, language, abstraction and orientation tasks compared with those without diabetes. According to the multiple linear analyses, having diabetes was significantly associated with lower global cognitive function, naming, and language scores, with coefficients and 95% CIs of -1.30 [ -2.59, -0.01], -0.25 [-0.47, -0.02], and -0.32 [-0.58, -0.07], respectively (all < 0.05). Having diabetes could not independently predict an increased risk of global cognitive impairment.
In MHD patients, having diabetes is significantly associated with lower cognitive function scores. Medical staff should evaluate early and focus on the decline of cognitive function in MHD patients with diabetes, in order to achieve early diagnosis and early intervention.
维持性血液透析（MHD）患者认知障碍的患病率高于普通人群，认知表现也较差，且认知障碍患者的死亡风险高于无认知障碍者。糖尿病与接受腹膜透析或肾移植治疗的终末期肾病患者认知功能下降风险增加有关。然而，这些发现可能不适用于血液透析人群。因此，我们旨在研究MHD患者患糖尿病与认知功能之间的关系。
这是一项横断面研究。来自两个血液净化中心的203例接受MHD治疗的患者被纳入研究对象。采用中文版蒙特利尔认知评估量表（MoCA）评估认知功能。
与无糖尿病的MHD患者相比，患糖尿病的MHD患者在整体认知障碍患病率以及在整体认知、视觉空间/执行功能、命名、语言、抽象和定向任务方面的表现明显较差。根据多元线性分析，患糖尿病与较低的整体认知功能、命名和语言得分显著相关，系数及95%可信区间分别为-1.30 [-2.59, -0.01]、-0.25 [-0.47, -0.02]和-0.32 [-0.58, -0.07]（均P<0.05）。患糖尿病不能独立预测整体认知障碍风险增加。
在MHD患者中，患糖尿病与较低的认知功能得分显著相关。医务人员应早期评估并关注糖尿病MHD患者的认知功能下降情况，以便实现早期诊断和早期干预。
