The impact of Naples prognostic score on cognitive impairment in hemodialysis patients: a multicenter study

Malnutrition and inflammation are prevalent in hemodialysis (HD) patients and linked to cognitive impairment (CI). Naples prognostic score (NPS) is a comprehensive measure of patients' inflammation and nutritional status. This study is to evaluate the association of NPS and CI risk in HD patients.

Two thousand seven hundred twenty-five HD patients were recruited and NPS score obtained based on albumin, total cholesterol (TC), lymphocytes, neutrophils, and monocytes. Cognitive function was assessed with Mini-Mental State Examination score (MMSE). Logistic regression models, interactive analyses were conducted.

Among 2725 HD patients, the prevalence of CI is 33.8%, the mean MMSE score was 26.9 ± 3.9. After adjusting clinical confounders, NPS showed a positive associated with CI both as a continuous variable (OR = 1.120, 95% CI 1.029-1.221, p = 0.009) and as a categorical variable (OR = 1.552, 95%CI: 1.146-2.110, p = 0.005). The analysis revealed a negative correlation between NPS and MMSE scores, observed both as a continuous variable (β = -0.178, 95% CI -0.321 to -0.035, p = 0.015) and as a categorical variable. Higher NPS was significantly associated with increased dementia risk (adjusted OR = 1.153, 95% CI 1.035-1.286, p = 0.010). Among CI patients, the proportion of males was higher than that of females. Subgroup analysis showed that the effect of NPS on CI was more pronounced in individuals under 65 years, without diabetes and cerebrovascular disease (CVD). Except for males, low education level, non-CVD, and HD frequency less than three times per week, the association between NPS and dementia was more significant.

NPS was associated with cognitive impairment in HD patients with a positive dose-response effect.