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Published on: April 23, 2021
Neurofilament Light Chain and Cognitive Dysfunction in Patients Undergoing Hemodialysis: A Cross-Sectional
Kazuhiko Kato1,2, Akio Nakashima1, Shunichiro Shinagawa3
1Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Key Points:
Blood biomarkers related to amyloid β and neurofilament light chain are used to predict cognitive decline in the general population. Evidence for their usefulness is lacking in patients receiving hemodialysis despite their high risk of cognitive impairment. Neurofilament light chain levels were negatively associated with cognitive function, whereas the amyloid β ratio was not.
Background:
Cognitive dysfunction is frequently observed in patients undergoing hemodialysis in clinical settings; however, its pathophysiology remains uncertain. In recent years, noninvasive blood biomarkers have garnered increasing attention in predicting Alzheimer's disease development. Within the general population, neurofilament light chain (NfL) levels have been used to prognosticate changes in cognitive function alongside the amyloid β (A β ) 1-42/1-40 ratio. Nevertheless, this has not been studied in patients with CKD, particularly those undergoing hemodialysis.
Methods:
This exploratory cross-sectional study investigated the association of the serum A β 1-42/1-40 ratio and NfL levels with cognitive function assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), in patients undergoing hemodialysis.
Results:
We included 384 patients with a median age of 74 (interquartile range [IQR], 70-80) years. The median (IQR) MoCA and MMSE scores were 25 (22-26) and 28 (26-29), respectively. The median (IQR) A β 1-42/1-40 ratio and NfL level were 0.04 (0.03-0.06) and 196.2 pg/ml (146.5-262.2), respectively. The multivariate linear regression analysis indicated a weak negative association between the log-transformed NfL levels and cognitive function, after adjusting for confounding factors including age ( β coefficient [95% confidence interval], -0.98 [-1.81 to -0.15]; P = 0.021 for MoCA and -0.66 [-1.32 to -0.01]; P = 0.046 for MMSE). However, the A β 1-42/1-40 ratio was not associated with cognitive function.
Conclusions:
Our exploratory analysis identified a weak negative association between serum NfL levels and cognitive function in patients undergoing hemodialysis.
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