[Association of malnutrition-inflammation-cardiovascular disease with cognitive deterioration in peritoneal dialysis patients]

Association of abdominal aortic calcification with cognitive impairment in peritoneal dialysis patients

BACKGROUND

Patients on peritoneal dialysis (PD) frequently have cognitive impairment, which is linked to a poor prognosis. The purpose of this study was to determine whether abdominal aortic calcification (AAC) may have an impact on PD patients' cognitive function.

METHODS

In this cross-sectional study of 110 PD patients, cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and AAC severity was quantified via lateral lumbar radiography (Kauppila method). Participants were stratified by AAC severity into high (HAAC; score ≥ 4) and low (LAAC; score < 4) groups.

RESULTS

Cognitive impairment (MoCA < 26) was present in 65.45% of patients. The HAAC group (71.8% of cohort) exhibited distinct metabolic profiles compared to LAAC: older age (63.2 ± 9.8 vs. 47.4 ± 12.1 years, P < 0.001), higher diabetes prevalence (68.4% vs. 22.6%, P < 0.001), elevated serum phosphorus (1.62 ± 0.45 vs. 1.30 ± 0.42 mmol/L, P < 0.001), and lower diastolic blood pressure (79.2 ± 10.8 vs. 86.6 ± 13.4 mmHg, P = 0.005). Notably, HAAC patients had reduced serum creatinine (898.4 ± 251.9 vs. 1190.7 ± 243.5 µmol/L, P < 0.001) and iPTH levels (142.5 vs. 218.0 pg/mL, P = 0.011), suggesting concurrent mineral bone disorder. Multivariate analysis identified AAC severity (OR = 1.28 per 1-point increase, 95%CI = 1.09-1.50) and age (OR = 1.12/year, 95%CI = 1.06-1.19) as independent predictors of cognitive impairment.

CONCLUSION

AAC severity demonstrates a strong, dose-dependent association with cognitive dysfunction in PD patients, independent of traditional risk factors. The combination of elevated phosphorus and suppressed iPTH in high-AAC patients highlights the potential role of mineral metabolism dysregulation in both vascular calcification and neurocognitive decline.

Increased serum methylmalonic acid levels were associated with the presence of cognitive dysfunction in older chronic kidney disease patients with albuminuria

BACKGROUND

This study aimed to evaluate the correlation between serum methylmalonic acid (MMA) levels and cognition function in patients with chronic kidney disease (CKD).

METHODS

In this cross-sectional study, we included 537 CKD individuals aged ≥ 60-year-old with albuminuria from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four cognitive tests including the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Delayed Recall and Word Learning tests, and the Animal Fluency test (AF) were performed. Associations between MMA and cognition scores were assessed with linear regression models.

RESULTS

MMA level was negatively associated with residual renal function and nutrition status. After multivariate adjustment, elevated serum MMA levels were independently correlated with decline of cognition in CKD patients with albuminuria.

CONCLUSION

Our study showed that higher serum MMA levels were independently associated with the presence of cognition dysfunction in CKD patients. The exact pathogenesis of MMA and cognition needs further research.