Kidney medicine · 2026
Cross-sectional Associations of Serum Sodium, Potassium, and Chloride with Cognition in Patients on Hemodialysis: The Osaka Dialysis Complication Study (ODCS).
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Shoji Tetsuo, Nakatani Shinya, Mori Katsuhito, Kabata Daijiro, Fujii Hisako, Nakaya Rino, Uedono Hideki, Nagata Yuki, Imanishi Yasuo, Morioka Tomoaki, Emoto Masanori
Аннотация
RATIONALE & OBJECTIVES: Cognitive function is impaired in patients with chronic kidney disease, particularly in those undergoing hemodialysis, although the precise mechanisms are not well understood. This cross-sectional study examined the possible relationship between serum electrolyte levels and cognitive function in patients receiving maintenance hemodialysis.
STUDY DESIGN: Cross-sectional study.
SETTINGS & PARTICIPANTS: Eligible patients were selected from the participants of the Osaka Dialysis Complication Study, a multicenter study conducted in Japan.
EXPOSURES: Serum sodium, potassium, and chloride levels.
OUTCOMES: Cognitive function assessed by the Modified Mini-Mental State examination (3MS) which was mathematically transformed to 3MS' to follow a normal distribution.
ANALYTICAL APPROACH: Multivariable-adjusted linear regression analysis.
RESULTS: For this study, 1,207 patients were selected. Their median age, 3MS score, serum sodium, potassium, and chloride concentrations were 67 (IQR, 60-74) years, 91 (IQR, 82-97) points, 139 (IQR, 137-141) mEq/L, 4.7 (IQR, 4.2-5.2) mEq/L, and 102 (IQR, 99-105) mEq/L, respectively. After adjustment, sodium (P = 0.23) or potassium (P = 0.38) were not associated with the 3MS score, whereas serum chloride was positively associated with the 3MS score (3MS', regression coefficient 0.100 [0.062, 0.138] per 1 IQR (6 mEq/L), P < 0.001) independently of potential confounders. The positive association between serum chloride and cognition was consistent in subgroup analysis. The difference in the 3MS score by 1 IQR of chloride was comparable to that of the difference by 7 years of age.
LIMITATIONS: Causality cannot be determined because of the cross-sectional design.
CONCLUSIONS: This study revealed that serum chloride level was a novel factor independently associated with cognitive performance in patients on maintenance hemodialysis, suggesting an unrecognized role of chloride in cognition.
STUDY DESIGN: Cross-sectional study.
SETTINGS & PARTICIPANTS: Eligible patients were selected from the participants of the Osaka Dialysis Complication Study, a multicenter study conducted in Japan.
EXPOSURES: Serum sodium, potassium, and chloride levels.
OUTCOMES: Cognitive function assessed by the Modified Mini-Mental State examination (3MS) which was mathematically transformed to 3MS' to follow a normal distribution.
ANALYTICAL APPROACH: Multivariable-adjusted linear regression analysis.
RESULTS: For this study, 1,207 patients were selected. Their median age, 3MS score, serum sodium, potassium, and chloride concentrations were 67 (IQR, 60-74) years, 91 (IQR, 82-97) points, 139 (IQR, 137-141) mEq/L, 4.7 (IQR, 4.2-5.2) mEq/L, and 102 (IQR, 99-105) mEq/L, respectively. After adjustment, sodium (P = 0.23) or potassium (P = 0.38) were not associated with the 3MS score, whereas serum chloride was positively associated with the 3MS score (3MS', regression coefficient 0.100 [0.062, 0.138] per 1 IQR (6 mEq/L), P < 0.001) independently of potential confounders. The positive association between serum chloride and cognition was consistent in subgroup analysis. The difference in the 3MS score by 1 IQR of chloride was comparable to that of the difference by 7 years of age.
LIMITATIONS: Causality cannot be determined because of the cross-sectional design.
CONCLUSIONS: This study revealed that serum chloride level was a novel factor independently associated with cognitive performance in patients on maintenance hemodialysis, suggesting an unrecognized role of chloride in cognition.