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腹膜透析患者认知障碍及潜在风险因素研究:一项观察性研究。

Research on cognitive impairment and potential risk factors in peritoneal dialysis patients: An observational study.

机构信息

Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China.

Department of Neurology, Beijing Shuangqiao Hospital, Beijing, China.

出版信息

Medicine (Baltimore). 2024 Jul 12;103(28):e38374. doi: 10.1097/MD.0000000000038374.

Abstract

The objective of this study is to investigate the associated risk factors and their effects on cognitive impairment (CI) in patients undergoing peritoneal dialysis. A retrospective analysis was conducted on the basic information of 268 patients who underwent continuous ambulatory peritoneal dialysis (CAPD) at our hospital from January 2020 to September 2023. Cognitive function was assessed using the Montreal Cognitive Assessment Scale during their subsequent dialysis visits. Participants were categorized into a CI group and a cognitively normal group. Blood and other biological samples were collected for relevant biomarker analysis. Subsequently, we analyzed and compared the factors influencing CI between the 2 groups. The prevalence of CI among CAPD patients was 58.2%. Compared to the cognitively normal group, the CI group had a higher prevalence of alcohol consumption, lower levels of education, and reduced serum uric acid levels (P < .05). There was also a higher incidence of autoimmune diseases such as systemic lupus erythematosus in the CI group (P < .05). In terms of dialysis efficacy, the residual kidney Kt/V and residual kidney Ccr were significantly lower in the CI group compared to the cognitively normal group. In blood parameters, the CI group showed elevated total cholesterol levels and lower serum calcium concentrations (P < .05). Logistic regression analysis identified male gender, older age, lower educational attainment, hypercholesterolemia, and elevated high-sensitivity C-reactive protein levels as independent risk factors for CI in CAPD patients (P < .05). Additionally, in this patient cohort, dialysis duration and residual renal function were protective factors against CI (P < .05). CI is prevalent among PD patients. Elevated high-sensitivity C-reactive protein levels, male gender, older age, lower educational attainment, and hypercholesterolemia constitute an independent risk factor for CI in CAPD patients, whereas residual renal function acts as a protective element.

摘要

本研究旨在探讨腹膜透析患者认知障碍(CI)的相关危险因素及其影响。对 2020 年 1 月至 2023 年 9 月在我院接受持续不卧床腹膜透析(CAPD)的 268 例患者的基本资料进行回顾性分析。在随后的透析就诊中,使用蒙特利尔认知评估量表评估认知功能。将患者分为 CI 组和认知正常组。采集血等生物样本进行相关生物标志物分析。然后,我们分析并比较了两组影响 CI 的因素。CAPD 患者 CI 的患病率为 58.2%。与认知正常组相比,CI 组饮酒比例较高,受教育程度较低,血尿酸水平降低(P<0.05)。CI 组自身免疫性疾病(如系统性红斑狼疮)的发病率也较高(P<0.05)。在透析效果方面,CI 组的残余肾 Kt/V 和残余肾 Ccr 明显低于认知正常组。在血液参数方面,CI 组总胆固醇水平升高,血清钙浓度降低(P<0.05)。Logistic 回归分析显示,男性、年龄较大、受教育程度较低、高胆固醇血症和高敏 C 反应蛋白水平升高是 CAPD 患者 CI 的独立危险因素(P<0.05)。此外,在该患者队列中,透析时间和残余肾功能是 CI 的保护因素(P<0.05)。CI 在 PD 患者中较为普遍。高敏 C 反应蛋白水平升高、男性、年龄较大、受教育程度较低和高胆固醇血症是 CAPD 患者 CI 的独立危险因素,而残余肾功能是保护因素。

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