Association of Abdominal Aortic Calcification with Cognitive Impairment in Peritoneal Dialysis Patients

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2025 Mar 11

PMID 40065265

Authors

Conghui Liu

Yanan Shi

Jiajie Cai

Tingting Bai

Jingjing Li

Lingju Yue

Zhongxin Li

Affiliations

Soon will be listed here.

Abstract

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.

References

Gadde K, Yin X, Goldberg R, Orchard T, Schlogl M, Dabelea D . Coronary Artery Calcium and Cognitive Decline in the Diabetes Prevention Program Outcomes Study. J Am Heart Assoc. 2023; 12(21):e029671. PMC: 10727391. DOI: 10.1161/JAHA.123.029671. View

Shoji T, Fujii H, Mori K, Nakatani S, Nagata Y, Morioka T . Associations of cardiovascular disease and blood pressure with cognition in hemodialysis patients: The Osaka Dialysis Complication Study. Nephrol Dial Transplant. 2021; 37(9):1758-1767. DOI: 10.1093/ndt/gfab247. View

Salazar-Felix N, Martin-Del-Campo F, Cueto-Manzano A, Romo-Flores M, Velazquez-Vidaurri A, Sanchez-Soriano A . Prevalence of mild cognitive impairment in automated peritoneal dialysis patients. Nephrol Dial Transplant. 2021; 36(11):2106-2111. DOI: 10.1093/ndt/gfab238. View

Zhang J, Wu L, Wang P, Pan Y, Dong X, Jia L . Prevalence of cognitive impairment and its predictors among chronic kidney disease patients: A systematic review and meta-analysis. PLoS One. 2024; 19(6):e0304762. PMC: 11146742. DOI: 10.1371/journal.pone.0304762. View

Ma Y, Xie W, Hou Z, An Y, Ren X, Ma Y . Association between coronary artery calcification and cognitive function in a Chinese community-based population. J Geriatr Cardiol. 2021; 18(7):514-522. PMC: 8352769. DOI: 10.11909/j.issn.1671-5411.2021.07.002. View

Dragos D, Timofte D, Georgescu M, Manea M, Vacaroiu I, Ionescu D . Cardiovascular Calcifications Are Correlated with Inflammation in Hemodialysis Patients. Medicina (Kaunas). 2023; 59(10). PMC: 10608311. DOI: 10.3390/medicina59101801. View

Gamage I, Dhar A, Tregaskis P, Wilson S . Frequency and risk factors for cognitive dysfunction in peritoneal dialysis patients. Nephrology (Carlton). 2022; 27(12):945-952. DOI: 10.1111/nep.14117. View

Ma D, Yan H, Yang X, Yu Z, Ni Z, Fang W . Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a prospective cohort study. BMC Nephrol. 2020; 21(1):151. PMC: 7191690. DOI: 10.1186/s12882-020-01822-9. View

Shi C, Jia S, Wang X, Liu C, Shao F, Shi Y . Research on cognitive impairment and potential risk factors in peritoneal dialysis patients: An observational study. Medicine (Baltimore). 2024; 103(28):e38374. PMC: 11245193. DOI: 10.1097/MD.0000000000038374. View

10.

Peeters M, van den Brand J, van Zuilen A, Koster Y, Bots M, Vervloet M . Abdominal aortic calcification in patients with CKD. J Nephrol. 2016; 30(1):109-118. PMC: 5316387. DOI: 10.1007/s40620-015-0260-7. View

11.

Duan L, Zheng Z, Zhang Y, Dong J . [Association of malnutrition-inflammation-cardiovascular disease with cognitive deterioration in peritoneal dialysis patients]. Beijing Da Xue Xue Bao Yi Xue Ban. 2019; 51(3):510-518. PMC: 7439037. DOI: 10.19723/j.issn.1671-167X.2019.03.020. View

12.

Niu Q, Zhao H, Wu B, Tsai S, Wu J, Zhang M . Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients. Blood Purif. 2019; 47 Suppl 1:8-16. PMC: 6518852. DOI: 10.1159/000496218. View

13.

Wang L, Bian X, Liu L, He Q, Xu J, Chen X . Association between cognitive function and skeletal muscle in patients undergoing maintenance hemodialysis. Front Endocrinol (Lausanne). 2024; 15:1324867. PMC: 10981270. DOI: 10.3389/fendo.2024.1324867. View

14.

Liao J, Wei Q, He Y, Liao Y, Xiong Z, Wang Q . Retinopathy is associated with impaired cognition in patients undergoing peritoneal dialysis. Ren Fail. 2023; 45(2):2258989. PMC: 10515682. DOI: 10.1080/0886022X.2023.2258989. View

15.

Wu C, Yu R, Li Q, Chen J, Wang W . Exploring the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). Medicine (Baltimore). 2023; 102(43):e35813. PMC: 10615453. DOI: 10.1097/MD.0000000000035813. View

16.

Li T, Hu Z, Qiao L, Wu Y, Ye T . Chronic kidney disease and cognitive performance: NHANES 2011-2014. BMC Geriatr. 2024; 24(1):351. PMC: 11027402. DOI: 10.1186/s12877-024-04917-2. View

17.

Mathur A, Ahn J, Sutton W, Chu N, Gross A, Segev D . Secondary hyperparathyroidism (CKD-MBD) treatment and the risk of dementia. Nephrol Dial Transplant. 2022; 37(11):2111-2118. PMC: 9585471. DOI: 10.1093/ndt/gfac167. View

18.

Wang J, Wu S, Zhang J, Li Y, Wu Y, Qi X . Correlation between gut microbiome and cognitive impairment in patients undergoing peritoneal dialysis. BMC Nephrol. 2023; 24(1):360. PMC: 10696889. DOI: 10.1186/s12882-023-03410-z. View

19.

Zhou T, Zhao J, Ma Y, He L, Ren Z, Yang K . Association of cognitive impairment with the interaction between chronic kidney disease and depression: findings from NHANES 2011-2014. BMC Psychiatry. 2024; 24(1):312. PMC: 11044494. DOI: 10.1186/s12888-024-05769-1. View

20.

Yi C, Lin J, Cao P, Chen J, Zhou T, Yang R . Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis. Sci Rep. 2018; 8(1):17305. PMC: 6251896. DOI: 10.1038/s41598-018-35548-4. View