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Published on: October 2, 2020
Low intracellular water and incident cognitive impairment in chronic hemodialysis patients
Maolu Tian1,2,3, Jing Yuan1, Fangfang Yu1
1Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
Insights
Low intracellular water (ICW), measured by bioelectrical impedance spectroscopy (BIS), is a significant risk factor for cognitive impairment (CI) in chronic hemodialysis patients. Monitoring ICW is crucial for assessing CI risk in this population.
Area of Science:
- Nephrology
- Neurology
- Body Composition Analysis
Background:
- Chronic hemodialysis (HD) patients are at increased risk for cognitive impairment (CI).
- Body composition, specifically intracellular water (ICW), is often altered in HD patients.
- Bioelectrical Impedance Spectroscopy (BIS) is a non-invasive method to assess body composition.
Purpose of the Study:
- To investigate the association between intracellular water (ICW) levels measured by BIS and the risk of developing incident cognitive impairment (CI).
- To determine if low ICW is an independent risk factor for CI in patients undergoing chronic hemodialysis.
Main Methods:
- An observational cohort study involving 3,385 chronic hemodialysis patients.
- Prospective monitoring for up to 3 years, with cognitive function assessed using the Mini-Mental State Examination (MMSE).
- Intracellular water (ICW) measured using a body composition monitor based on BIS; statistical analysis using multiple Cox regression models.
Main Results:
- A significant increase in CI incidence was observed with decreasing quartiles of ICW.
- Low baseline ICW was independently associated with a higher risk of incident CI, even after adjusting for multiple confounding factors.
- Residual renal function was found to have an interactive role in the association between ICW and incident CI.
Conclusions:
- Low baseline intracellular water (ICW) is an independent risk factor for cognitive impairment (CI) in chronic hemodialysis (HD) patients.
- Bioelectrical Impedance Spectroscopy (BIS) is a valuable tool for assessing body composition and predicting CI risk in HD patients.
- Clinical assessment of HD patients should include body composition analysis using BIS to identify individuals at higher risk for cognitive decline.
Objective:
To explore the effect of intracellular water (ICW) evaluated by the bioelectrical Impedance Spectroscopy (BIS) on the risk of incident cognitive impairment (CI) in chronic hemodialysis (HD) patients.
Methods:
Three thousand three hundred eighty-five patients were recruited and monitored prospectively for up to 3 years (the median follow-up time, 2 years) in this observational cohort study. Mini-Mental State Examination score (MMSE) was used to assess the global cognitive function. ICW was measured by body composition monitor based on BIS. Multiple Cox regression models, stratified analyses, and interactive analyses were conducted.
Results:
During the follow-up period, 1256 patients (37.1%) experienced incident CI. The incidence of CI was increased with decreasing quartiles of ICW (27.4%, 32.2%, 38.9%, and 50.1% for the fourth, third, second, and first quartiles, respectively). Decreased ICW was significantly associated with incident CI. The association remained statistically significant even after adjusting for age, sex, education, albumin, C-reactive protein, residual renal function and various medical histories. The hazard ratios were 1.38 (1.17-1.64) and 1.28 (1.08-1.52) for ICW quartile 1 and quartile 2, respectively (reference, quartile 4). The association stably existed across subgroups, and the residual renal function had an interactive role in the association between ICW and incident CI (p = 0.014).
Conclusion:
Low baseline ICW was an independent risk factor for CI in chronic HD patients. Our finding highlights the necessity of using BIS to measure body composition when assessing the risk of CI in HD patients.
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