A Higher Whole-Body Extracellular to Intracellular Water Ratio Is Associated with Increased Odds of Cognitive Impairment in Hemodialysis Patients

Article type: Research Article

Authors: Zhou, Chaomin^{a; b; 1} | Zhan, Lin^{c; 1} | He, Pinghong^a | Yuan, Jing^a | Zha, Yan^{a; b; *}

Affiliations: [a] Department of Nephrology, NHC Key Laboratory of Pulmonary Immune-related Diseases, Renal Division, Guizhou Provincial People’s Hospital, Guiyang, China | [b] Medical College, Gui Zhou University, Guiyang, China | [c] Research Laboratory Center, Guizhou Provincial People’s Hospital, Guiyang, China

Correspondence: [*] Correspondence to: Yan Zha, NHC Key Laboratory of Pulmonary Immune-related Diseases, Renal Division, Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, 550002, China. Tel.: +8613639106123; E-mail: zhayan72@126.com.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Cognitive impairment (CI) is highly prevalent in patients undergoing hemodialysis. Whether fluid overload with malnutrition as assessed by the ratio of extracellular water to intracellular water (ECW/ICW) is associated with CI in patients on maintenance hemodialysis (MHD) has yet to be studied. Objective:This study aimed to investigate the association between ECW/ICW and CI in patients with MHD. Methods:We conducted a multicenter, cross-sectional study that enrolled 3,025 adult patients with MHD. Cognitive function was assessed through the Mini-Mental State Examination. The ECW/ICW was derived from a portable body composition monitor and analyzed by quartiles. Results:23.04% of participants had CI in our study. The prevalence of CI tended to increase as the quartiles of the ECW/ICW ratio increased. Unadjusted analysis showed that participants in quartile 4 were 3.02 times more likely to have a CI compared to those in quartile 1. After adjusting for age, sex, education, smoking status, body mass index, dialysis vintage, history of hypertension, and history of stroke, the adjusted OR (95% CI) for the highest quartile of ECW/ICW ratio was 1.36 (1.01, 1.83) for CI compared with the lowest quartile. Interestingly, the association between ECW/ICW ratio and CI persisted across all subgroups stratified by age, gender, history of diabetes, and stroke. (p for interaction > 0.05 for all). Conclusion:An increased ECW/ICW ratio is associated with higher odds of cognitive impairment in patients undergoing hemodialysis.

Keywords: Alzheimer’s disease, cognitive impairment, extracellular water to intracellular water ratio, fluid overload, maintenance hemodialysis

DOI: 10.3233/JAD-230196

Journal: Journal of Alzheimer's Disease, vol. 95, no. 1, pp. 171-179, 2023