Clinical Characteristics and Influencing Factors of Cognitive Impairment in Patients With End-Stage Renal Disease Undergoing Maintenance Haemodialysis

Abstract

Background: This study aimed to investigate the clinical characteristics and influencing factors of cognitive impairment and associated behavioural and psychological symptoms in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis.

Methods: This study enrolled 132 patients with ESRD receiving maintenance haemodialysis between January 2021 and January 2025. Patients were divided into a cognitively normal (CN) group and a cognitively impaired (CI) group based on post-dialysis cognitive impairment. The relationships were examined using the Montreal Cognitive Assessment (MoCA) and the Neuropsychiatric Inventory (NPI). Clinical data were collected, and logistic regression analysis was performed to identify factors associated with cognitive impairment.

Results: Compared with the CN group, the CI group had significantly higher scores in abstract thinking, orientation, memory, naming, visuospatial/executive abilities, language fluency, attention and total MoCA scores (p < 0.05). On the NPI, the CI group had significantly lower scores (indicating fewer symptoms) than the CN group across all 12 domains, including delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor activity, nighttime behaviours/sleep disturbances, and appetite/eating disorders, as well as higher total NPI scores (p < 0.05). Logistic regression analysis identified age, dialysis duration, and serum levels of haemoglobin (Hb), higher β₂-microglobulin, 25-hydroxyvitamin D [25(OH)D], and higher intact parathyroid hormone (iPTH) as independent influencing factors associated with cognitive impairment (p < 0.05).

Conclusions: Advanced age, longer dialysis duration, lower Hb, higher β₂-microglobulin, lower 25(OH)D, and higher iPTH levels were associated with cognitive impairment in patients undergoing maintenance haemodialysis for ESRD. Close monitoring of patients presenting with these risk factors is warranted for early prevention of cognitive decline.