Cognitive impairment, endothelial biomarkers and mortality in maintenance haemodialysis patients: a prospective cohort study

医学 内科学 危险系数 比例危险模型 生物标志物 队列 前瞻性队列研究 认知功能衰退 置信区间 疾病 心脏病学 痴呆 生物化学 化学
作者
Camilla Maroni Marques Freire de Medeiros,Bruna Rafaele Diógenes da Silva,Bruna Dillyane Sousa Costa,Vinicius Farina Sartori,Gdayllon Cavalcante Meneses,Gabriela Freire Bezerra,Alice Maria Costa Martins,Alexandre Braga Libório
出处
期刊:Nephrology Dialysis Transplantation [Oxford University Press]
卷期号:35 (10): 1779-1785 被引量:9
标识
DOI:10.1093/ndt/gfaa040
摘要

Abstract Background Haemodialysis (HD) patients have a high prevalence of cardiovascular disease risk factors as well as cognitive impairment. The objective of the present study was to evaluate the interrelationship between cognitive impairment, endothelium-related biomarkers and cardiovascular/non-cardiovascular mortality. Methods A total of 216 outpatients were recruited from three centres in a dialysis network in Brazil between June 2016 and June 2019. Sociodemographic and clinical data were obtained by applying a patient questionnaire, reviewing medical records data and conducting patient interviews. Cognitive function was assessed using the Cambridge Cognitive Examination. Plasma endothelium-related biomarkers [syndecan-1, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1) and angiopoietin-2 (AGPT2)] were measured. Patients were followed for 30 months. Cox proportional hazards regression models were used to assess the associations of the cognitive function scores and each endothelium-related biomarker with cardiovascular/non-cardiovascular mortality. Results Cognitive function was associated with cardiovascular mortality {each standard deviation [SD] better cognitive score was associated with a 69% lower risk for cardiovascular mortality [hazard ratio (HR) 0.31 [95% confidence interval (CI) 0.17–0.58]} but not with non-cardiovascular mortality. Moreover, cognitive function was also correlated with all endothelial-related biomarkers, except VCAM-1. ICAM-1, AGPT2 and syndecan-1 were also associated with cardiovascular mortality. The association between cognitive function and cardiovascular mortality remained significant with no HR value attenuation [fully adjusted HR 0.32 (95% CI 0.16–0.59)] after individually including each endothelial-related biomarker in the Cox model. Conclusions In conclusion, cognitive impairment was associated with several endothelium-related biomarkers. Moreover, cognitive impairment was associated with cardiovascular mortality but not with non-cardiovascular mortality, and the association between cognitive impairment and cardiovascular mortality in HD patients was not explained by any of the endothelial-related biomarkers.
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