#6696 COGNITIVE IMPAIRMENT IN PATIENTS ON HEMODIALYSIS EXPERIENCE FROM A CENTER IN SANTA ROSA GUATEMALA
Authors: Campos Celso Mazariegos , Pérez María Palencia , Cuesta Herbert Ferrer , Avendaño Carlos , Polo José Vicente Sánchez 
Published: June 2023

Abstract

Background and Aims
Cognitive impairment in patients with chronic kidney disease (CKD) involves multiple factors such as inflammation, uremic toxins and endothelial dysfunction, having rates of up to 10.7 cases per 1000/patient year and that can increase in renal replacement therapy (RRT). The cognitive impairment can progress to dementia and this has adverse long-term outcomes such as mortality. The prevalence of cognitive impairment is 19% to 77% in patients with hemodialysis therapy. The aims of this study was determine the prevalence of cognitive impairment in hemodialysis patients and possible associated factors.

Method
A cohort study was conducted in a hemodialysis unit of Santa Rosa, Guatemala. Patients over 18 years of age were included with more than two months of having started hemodialysis and with 3 sessions per week. Patients with a previous diagnosis of dementia, with visual-hearing deficits, illiterate, a history of cerebrovascular events or psychiatric disorders and who did not agree to participate in the study were excluded. For cognitive assessment, the Montreal Cognitive Assessment tool (MoCA test) was used, taking a score of less or equal than 26 points as cognitive impairment. A value of p&lt;0.05 was taked significant.

Results
78 patients were screened, however 30 patients were discarded due to exclusion criteria. A total of 48 patients were analyzed. A mean age was of 51 years, the majority of whom were male, 40% had only a basic level of education and 38% did not know the cause of CKD. Arterial hypertension was the most frequent comorbidity and the most used antihypertensive were beta-blockers. As for medications for complications of CKD, vitamin D and erythropoietin are the most used. The patients had an average time on hemodialysis of 41.3 months, the last calculated Kt/V was of 1.73 (mean), the mean hemoglobin level was 9.9 g /dl and the mean MoCA test score performed for the study was 23.3 points. Regarding the primary objective, it was determined that the prevalence of cognitive impairment was 67% and when analyzing the variables it was found that age and level of education are associated with greater cognitive impairment, older patients (p: 0.002) and with lower level of education (p: 0.02). In analysis the cognitive domains, it is founded that those patients who present alterations in the attention and delayed recall domain are those that are statistically more associated with cognitive impairment and their counterpart those who have conserved the naming and language domain are those that are associated with having a normal global cognitive practice (Table 1). A correlation analysis was performed where it was found that there is a negative correlation which is moderate and statistically significant between age and the MoCA test score (Table 2).

Conclusion
The prevalence of cognitive impairment was 67%, age and educational level seem to be influencing factors, with older patients and those with lower educational level being the most affected. Within the cognitive domains, attention and delayed recall are the most affected and most associated with cognitive impairment. It is important to conduct further studies evaluating other variables that have been shown to influence cognitive status such as vitamin B12, vitamin D and homocysteine. It is important to perform cognitive evaluation of patients on hemodialysis and other RRT to have an early diagnosis and intervene early considering that cognitive impairment can progress to dementia and this is a cause of abandonment in treatment and mortality.