Longitudinal Assessment of Cognitive Decline in Hemodialysis Patients: Unveiling Sex Disparities Sex and cognitive decline in hemodialysis patients

Abstract Background Numerous studies have delved into the prevalence, risk factors, and outcomes associated with cognitive impairment in hemodialysis patients. However, a scarcity of data exists regarding the trajectory of cognitive decline and potential contributing factors. Methods We recruited 247 prevalent hemodialysis patients for this study. Baseline and follow-up cognitive assessments were conducted in 90 patients using the Montreal Cognitive Assessment (MoCA) at a two-year interval. To identify potential predictors of cognitive decline, we analyzed traditional risk factors alongside dialysis-related variables. Additionally, surrogate parameters of vascular calcification and arterial stiffness, such as T50 values and pulse wave velocity, were investigated. Results After a two-year follow-up period (24.3 ± 1.05 months), MoCA test results revealed a significant decline in cognitive function (- 1.8 ± 3.2 points, p < 0.001). Overall, 37 patients (41%) exhibited cognitive decline, defined as a decrease in MoCA score of more than 2 points, indicating disease progression. The median change in MoCA score differed significantly between males (-3.0, range 0.0 to -5 points) and females (0.0, range 1.0 to -1.75 points, p = 0.002). This finding was corroborated by multivariable analyses adjusted for age, educational level, diabetes and blood pressure measurements (regression coefficient -2.5, p = 0.006). The association was further confirmed in a comparison between patients with stable and declining cognitive function (regression coefficient 2.65, odds ratio 14.2, p = 0.007). None of the other variables reached statistical significance. Conclusions Our findings underscore a substantial deterioration in cognitive function over time among hemodialysis patients. Notably, our data reveal a more rapid decline in cognitive function among males, shedding light on previously unrecognized sex differences in this patient population.