Prevalence and Pattern of Cognitive Impairment in Patients on Maintenance Hemodialysis

Background Despite the rising burden of end-stage renal disease (ESRD), cognitive assessment is not routinely incorporated into dialysis care, particularly in low-resource settings. This study aimed to assess the prevalence, severity, and predictors of cognitive impairment among patients on maintenance hemodialysis. Methods A descriptive cross-sectional study was conducted at a tertiary dialysis center from December 2023 to May 2024. Patients aged ≥18 years undergoing hemodialysis for six months or more were enrolled. Exclusion criteria included neurological disorders, severe psychiatric illness, or medications affecting cognition. Cognitive function was evaluated using the Urdu-validated Montreal Cognitive Assessment (MoCA), with scores <26 indicating impairment. Domain-wise deficits were classified using 1.5 standard deviation below the normative mean. Statistical analysis included chi-square tests, t-tests, and multivariable logistic regression. Results Out of 198 hemodialysis patients, 116 (58.6%) exhibited cognitive impairment. Severity was categorized as mild in 79 (39.9%), moderate in 31 (15.7%), and severe in eight (4.0%) patients. Multidomain impairment was present in 108 (54.5%), while 18 (9.1%) had single-domain and 72 (36.4%) had no impairment. Older age (p<0.001), lower education (p<0.001), low socioeconomic status (SES) (p=0.045), and longer dialysis duration (p<0.001) were significantly associated with cognitive impairment. Biochemical predictors included lower hemoglobin and albumin (p=0.018 and p=0.034), and higher phosphate and intact parathyroid hormone (iPTH) (p=0.001 and p=0.042). On regression analysis, age (adjusted odds ratio (AOR)=1.088, 95% confidence interval (CI)=1.031-1.149), education ≤12 years (AOR=10.423, 95% CI=1.199-90.633), low SES (AOR=9.075, 95% CI=1.473-55.916), dialysis duration (AOR=1.047, 95% CI=1.010-1.085), and biochemical markers remained significant. Conclusion Cognitive impairment, particularly multidomain, is highly prevalent among hemodialysis patients and frequently unrecognized. Integration of cognitive screening into routine nephrology care is essential to enable early intervention and improve long-term patient outcomes.