The Relationship Between Cognitive Function and Having Diabetes in Patients Treated with Hemodialysis

Purpose: Patients undergoing maintenance hemodialysis (MHD) have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population, and those with cognitive impairment are at higher risk of death than those without cognitive impairment. Having diabetes has been associated with an increased risk of cognitive decline in end-stage kidney disease patients treated with peritoneal dialysis or kidney transplant. However, these findings may not extend to the hemodialysis population. Thus, we aim to investigate the relationship between having diabetes and cognitive function in MHD patients.

Methods: This was a cross-sectional study. A total of 203 patients treated with MHD from two blood purification centers were enrolled as subjects. The Chinese version of the Montreal Cognitive Assessment (MoCA) was utilized to assess cognitive function.

Results: MHD patients with diabetes had a significantly higher prevalence of global cognitive impairment and inferior performance in global cognition, visuospatial/executive function, naming, language, abstraction and orientation tasks compared with those without diabetes. According to the multiple linear analyses, having diabetes was significantly associated with lower global cognitive function, naming, and language scores, with coefficients and 95% CIs of -1.30 [ -2.59, -0.01], -0.25 [-0.47, -0.02], and -0.32 [-0.58, -0.07], respectively (all  < 0.05). Having diabetes could not independently predict an increased risk of global cognitive impairment.

Conclusions: In MHD patients, having diabetes is significantly associated with lower cognitive function scores. Medical staff should evaluate early and focus on the decline of cognitive function in MHD patients with diabetes, in order to achieve early diagnosis and early intervention.