Yuan Dan, Sun Zhenxing, Zhou Jingjing, Wang Xiaoqi, Li Zhongxin
Department of Nephrology, Beijing Luhe Hospital, Capital Medical University 82 Xinhua South Road, Tongzhou District, Beijing 101100, China.
Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University 168 Litang Road, Changping District, Beijing 102218, China.
Am J Transl Res. 2024 Sep 15;16(9):4504-4514. doi: 10.62347/HFGL5701. eCollection 2024.
To examine the relationship between cognitive impairment and body composition indicators in chronic kidney disease (CKD) patients post-hemodialysis.
This retrospective study included 110 CKD patients admitted to Beijing Luhe Hospital, Capital Medical University between January 2019 and January 2023. General clinical data and body composition indicators were compared between patients with and without cognitive impairment. Multiple logistic regression and ROC curve analysis were used to identify influencing factors and to develop a predictive model.
Cognitive impairment occurred in 50% of the patients post-hemodialysis. No significant differences were found in demographics, disease duration, comorbidities, or hemodialysis duration between the groups (all P > 0.05). However, significant differences were observed in body mass index (BMI) (P < 0.001), lean body mass index (LTI) (P = 0.007), fat tissue index (FTI) (P = 0.024), and total body water (TBW) (P < 0.001). Multiple logistic regression identified TBW (OR 4.900, 95% CI 3.062-7.511, P < 0.001), the TBW/extracellular water (ECW) ratio (OR 7.244, 95% CI 5.092-8.7613, P = 0.016), and the ECW/body cell mass (BCM) ratio (OR 6.720, 95% CI 4.564-8.692, P = 0.030) as independent risk factors for cognitive impairment post-hemodialysis. ROC analysis confirmed their predictive capacity, with AUC values of 0.840, 0.840, and 0.850 respectively. A predictive model incorporating these indicators was developed, showing good calibration (Hosmer-Lemeshow test, P = 0.912) and discrimination (C-index 0.974, 95% CI 0.952-0.997).
Total body water, the TBW/ECW ratio, and the ECW/BCM ratio are independently associated with cognitive impairment in CKD patients post-hemodialysis. Body composition analysis serves as a valuable tool for predicting cognitive impairment in this population, guiding clinicians in assessing cognitive function and planning interventions for these patients.
探讨慢性肾脏病（CKD）患者血液透析后认知障碍与身体成分指标之间的关系。
这项回顾性研究纳入了2019年1月至2023年1月期间首都医科大学附属北京潞河医院收治的110例CKD患者。比较有认知障碍和无认知障碍患者的一般临床资料和身体成分指标。采用多因素logistic回归和ROC曲线分析来确定影响因素并建立预测模型。
血液透析后50%的患者出现认知障碍。两组在人口统计学、病程、合并症或血液透析时间方面均无显著差异（均P>0.05）。然而，在体重指数（BMI）（P<0.001）、瘦体重指数（LTI）（P=0.007）、脂肪组织指数（FTI）（P=0.024）和总体水（TBW）（P<0.001）方面观察到显著差异。多因素logistic回归确定TBW（比值比4.900，95%置信区间3.062-7.511，P<0.001）、TBW/细胞外液（ECW）比值（比值比7.244，95%置信区间5.092-8.7613，P=0.016）和ECW/身体细胞质量（BCM）比值（比值比6.720，95%置信区间4.564-8.692，P=0.030）是血液透析后认知障碍的独立危险因素。ROC分析证实了它们的预测能力，AUC值分别为0.840、0.840和0.850。建立了一个包含这些指标的预测模型，显示出良好的校准度（Hosmer-Lemeshow检验，P=0.912）和区分度（C指数0.974，95%置信区间0.952-0.997）。
总体水、TBW/ECW比值和ECW/BCM比值与CKD患者血液透析后的认知障碍独立相关。身体成分分析是预测该人群认知障碍的有价值工具，可指导临床医生评估认知功能并为这些患者制定干预计划。
