Malnutrition-inflammation is a risk factor for cerebral small vessel diseases and cognitive decline in peritoneal dialysis patients: a cross-sectional observational study

BMC Nephrology

Research Article

Qun Xu¹  Kai Luo¹  Ke Zheng²  Haiyun Wang²  Xuemei Li²  Limeng Chen²  Mingxi Li²  Jing Yuan³  Yicheng Zhu³  Liying Cui³  Feng Feng⁴  Hui You⁴  Bo Hou⁴  Sagar Uday Nigwekar⁵ 

[1] Department of Epidemiology and biostatistics, Institute of basic medical sciences, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China;Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, 100730, Beijing, People’s Republic of China;Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China;Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China;Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, USA;

关键词: Peritoneal dialysis;    Cerebral small vessel disease;    Cognitive function;    Malnutrition;    Inflammation;   

DOI  :  10.1186/s12882-017-0777-1

 received in 2017-07-02, accepted in 2017-11-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundChronic kidney disease patients have an increased prevalence of subclinical cerebrovascular diseases. Dialysis patients have severe vascular diseases burden. The cerebral small vessel diseases (CSVD) are difficult to find by clinical assessment. The evaluation of CVSD needs MRI. Cognitive impairment is a consequence of CVSD which is diagnosed by cognitive testing. These limited the study of CVSD and cognitive function in dialysis patients. Peritoneal dialysis (PD) patients are minority of dialysis population. We know even fewer about the CVSD in this special population.MethodsIn this cross-sectional study, we enrolled 72 PD patients who received care at the Peking Union Medical College hospital peritoneal dialysis center. CSVD were assessed by brain MR images. Cognitive function was evaluated with the Chinese version of the MMSE and MoCA.ResultsIn our PD patients, the brain MRI showed the prevalence different signs of CSVD were: lacunar infarcts 38.9%, microbleeds 36.1%, abnormal brain white matter hyperintensities (WMHs) 48.6%, and intracerebral hemorrhage 4.2%. 25% and 86.8%of our patients could be diagnosed as cognitive impairment, according to the MMSE and MoCA test, respectively. nPCR was lower in patients with a lacunar infarct or intracerebral hemorrhage, and relative to the MMSA/MoCA score; hsCRP was higher in patients with lacunar infarct or abnormal WMHs and negative relative to the MMSA/MoCA score. In logistic regression analyses, nPCR was an independent risk factor for lacunar infarcts and impaired cognitive function. The presence of lacunar infarct was an independent risk factor for cognitive function decline.ConclusionWe demonstrated a high prevalence of CSVD and cognitive impairment in our PD patients. Lacunar infarct was the main kind of CVSD responsible for PD patients cognitive function decline. Our novel observation also revealed an association between malnutrition-inflammation and CSVD.

【 授权许可】

CC BY   
© The Author(s). 2017