Mind Over Matter: Cognitive Decline in Hemodialysis Patients: A Cross-sectional Analysis.

Introduction: Chronic kidney disease (CKD) affects up to 15% of the global population, with cognitive impairment frequently reported in patients, particularly those undergoing hemodialysis (HD). The study aims to analyze cognitive performance differences between patients receiving conservative management and those on HD in India.

Materials and methods: This observational cross-sectional study was conducted between September 2021 and April 2023, involving 1214 end-stage CKD patients - 604 on conservative therapy and 610 on HD. Neurocognitive assessment tools included the abbreviated mini-mental state examination (MMSE), Addenbrooke's cognitive examination III (ACE-III), Grober and Buschke Test, Trail Making Tests, Stroop Test, and Boston Naming Test. Statistical analysis utilized the Wilcoxon and Chi-square tests for group comparisons.

Results: The HD group demonstrated significantly lower scores in the ACE-III visuospatial domain (P = 0.00685) and verbal inhibitory control (P = 0.011) assessed by the INECO frontal screening test. No significant differences were observed in global cognitive performance based on MMSE or other ACE-III domains. In addition, 16.7% of HD patients had deficient Stroop test scores, and 33.3% were unable to complete it due to visual difficulties.

Discussion: The findings highlight selective deficits in frontal-executive functions among HD patients, potentially reflecting subcortical and vascular pathophysiology due to hemodynamic stress and cerebral hypoperfusion. These results underscore the need for routine cognitive screening in CKD patients to guide treatment strategies.

Conclusion: Patients with end-stage CKD on HD exhibited significant impairments in executive function compared to those under conservative management. Incorporating neurocognitive evaluations into clinical practice can enhance treatment decision-making and improve patient outcomes.