Risk factors for cognitive impairment in patients undergoing hemodialysis: an umbrella review and meta-analysis.
Jun Liu, Jing-Fang Wan, Jia Chen et al.
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In 30 seconds
This umbrella review and meta-analysis examined factors associated with cognitive impairment and cognitive frailty in adults receiving maintenance hemodialysis. It included five meta-analyses covering 97 associations. Several demographic, clinical, and dialysis-related factors were associated with these outcomes, with different patterns for cognitive impairment and cognitive frailty. Higher education was associated with lower odds of cognitive impairment (OR = 0.21, 95% CI: 0.13-0.34); depression was associated with higher odds of cognitive frailty (OR = 4.66, 95% CI: 2.98-7.27). Evidence certainty was moderate for only two associations and low or very low for all others.
Key findings
- Higher educational attainment was associated with reduced cognitive impairment (OR = 0.21, 95% CI: 0.13-0.34).
- Depression was associated with cognitive frailty (OR = 4.66, 95% CI: 2.98-7.27).
- Stroke history, longer dialysis duration, low-flux hemodialysis, and interdialytic hypotension were also associated with increased cognitive frailty.
- Only two associations had moderate-certainty evidence; all other associations were rated low or very low certainty.
Why it matters
Cognitive impairment and cognitive frailty are distinct outcomes, and their associated factors may differ. The review highlights potentially relevant demographic, health, nutritional, and dialysis-related correlates, while the generally low certainty cautions against treating these associations as established causes. Separating the outcomes and improving the quality of prospective evidence may help clarify how cognitive vulnerability is assessed in people receiving hemodialysis.
What to keep in mind
Most associations were supported by low- or very-low-certainty evidence, and the review calls for further high-quality prospective studies.