Ankle-brachial index rather than brachial-ankle pulse wave velocity is associated with cognitive function in older adults undergoing incident hemodialysis: a multicentre cross-sectional study.

BACKGROUND AND AIMS: Hemodialysis (HD) patients frequently experience cognitive impairment, potentially linked to arterial stiffness. However, the correlation between specific arterial stiffness and cognitive performance in hemodialysis patients has not been confirmed. The aim of this study was to examine the association between cognitive impairment and arterial stiffness in HD patients.

METHODS

This cross-sectional study included HD patients undergoing hemodialysis treatment from seven hemodialysis centers in China. We determined arterial stiffness by brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) and assessed participants' cognitive function using the Mini-Mental State Examination (MMSE).

RESULTS

A total of 889 HD participants were enrolled, with a mean age of 61.4 years, 37.6% being female, a median HD duration of 43.7 months, and 16.4% exhibiting cognitive impairment. Compared with the group with normal cognitive function, patients with cognitive impairment had higher baPWV (21.1 ± 5.8 vs 19.3 ± 4.8) and lower ABI (1.06 ± 0.21 vs 1.13 ± 0.17) (p < 0.05). In logistic regression analysis, the highest quartile of ABI was found to have a statistically significant association with cognitive impairment compared to the lowest quartile (odds ratio [OR]: 0.576; 95% confidence interval [CI]: 0.335-0.989) (P for trend = 0.031). Additionally, per standard deviation (SD) increase in ABI was associated with lower odds of cognitive impairment (OR: 0.753; 95% CI: 0.620-0.915). However, in baPWV, we did not find a statistically significant difference (OR: 1.155; 95% CI: 0.964-1.383).

CONCLUSIONS

Lower ABI, which is indicative of blockage of blood vessels in the lower limbs, is associated with declining cognitive function in patients on hemodialysis.

CLINICAL TRIAL REGISTRATION: ChiCTR1900027039.