Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Nephron. 2021;145(2):171-178. doi: 10.1159/000513327. Epub 2021 Feb 8.
The prevalence of cognitive impairment in patients undergoing hemodialysis (HD) is higher than that in healthy controls. To date, studies on the association between cognitive function and cerebral oxygenation in these patients are limited. Therefore, in this study, we aimed to cross-sectionally investigate the association between cognitive assessment scores and clinical factors, including cerebral oxygenation, in patients undergoing HD.
In this observational study, 193 HD patients were included. Cerebral regional oxygen saturation (rSO2) was monitored using an INVOS 5,100c oxygen saturation monitor. Poor cognition was defined as a Mini-Mental State Examination (MMSE) score ≤23. We analyzed the association between MMSE score and clinical factors, including cerebral rSO2.
MMSE score in HD patients included in this study was 26.8 ± 3.3. There were 164 patients (85%) with MMSE score ≥24 and 29 patients (15%) with an MMSE score ≤23. In the patients with MMSE score ≥24, cerebral rSO2 (53.8% ± 8.3%) was significantly higher than that in patients with MMSE score ≤23 (49.5% ± 9.8%; p = 0.013). Multivariable linear regression analysis was performed using the following confounding factors: age, mean blood pressure, cerebral rSO2, HD duration, ultrafiltration rate, hemoglobin, serum Cr, serum calcium, serum phosphate, total cholesterol, high-density lipoprotein cholesterol levels, serum albumin, presence of diabetes mellitus or chronic glomerulonephritis, history of comorbid cardiovascular or cerebrovascular disease, and use of renin-angiotensin-aldosterone system inhibitors or vitamin D analogs. MMSE score was independently and significantly associated with age (standardized coefficient: -0.244) and cerebral rSO2 (standardized coefficient: 0.180).
MMSE score was independently associated with age (negative effect) and cerebral rSO2 (positive effect) in this cross-sectional study. Further prospective studies are needed to clarify whether maintaining cerebral oxygenation prevents the deterioration of cognitive function in patients undergoing HD.
接受血液透析（HD）治疗的患者认知障碍的发生率高于健康对照组。迄今为止，关于这些患者认知功能与脑氧合之间关联的研究有限。因此，在本研究中，我们旨在横截面对接受 HD 治疗的患者的认知评估评分与包括脑氧合在内的临床因素之间的关联进行研究。
在这项观察性研究中，共纳入 193 名 HD 患者。使用 INVOS 5100c 氧饱和度监测仪监测脑区域性氧饱和度（rSO2）。认知功能差定义为简易精神状态检查（MMSE）评分≤23。我们分析了 MMSE 评分与包括 rSO2 在内的临床因素之间的关联。
纳入本研究的 HD 患者的 MMSE 评分为 26.8±3.3。164 名患者（85%）的 MMSE 评分≥24，29 名患者（15%）的 MMSE 评分≤23。在 MMSE 评分≥24 的患者中，脑 rSO2（53.8%±8.3%）显著高于 MMSE 评分≤23 的患者（49.5%±9.8%；p=0.013）。使用以下混杂因素进行多元线性回归分析：年龄、平均血压、脑 rSO2、HD 持续时间、超滤率、血红蛋白、血清 Cr、血清钙、血清磷、总胆固醇、高密度脂蛋白胆固醇水平、血清白蛋白、是否患有糖尿病或慢性肾小球肾炎、是否患有合并心血管或脑血管疾病病史，以及是否使用肾素-血管紧张素-醛固酮系统抑制剂或维生素 D 类似物。MMSE 评分与年龄（标准化系数：-0.244）和脑 rSO2（标准化系数：0.180）独立且显著相关。
在这项横断面研究中，MMSE 评分与年龄（负效应）和脑 rSO2（正效应）独立相关。需要进一步的前瞻性研究来阐明维持脑氧合是否可以防止接受 HD 治疗的患者认知功能的恶化。
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