Longitudinal assessment of cognitive decline in hemodialysis patients: unveiling sex disparities
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 2-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 2-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 >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.
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BibTeX
@article{schafer2026longitudinal,
title = {{Longitudinal assessment of cognitive decline in hemodialysis patients: unveiling sex disparities}},
author = {Hannah Schäfer and Matthias Braunisch and Roman Günthner and Claudius Küchle and Michael Basta-Wunderle and Bernhard Haller and Uwe Heemann and Christoph Schmaderer and Susanne Angermann},
journal = {Clinical kidney journal},
year = {2026},
month = oct,
doi = {10.1093/ckj/sfag340},
url = {https://europepmc.org/article/PMC/PMC13724265},
note = {CC BY},
}
RIS
TY - JOUR
TI - Longitudinal assessment of cognitive decline in hemodialysis patients: unveiling sex disparities
AU - Hannah Schäfer
AU - Matthias Braunisch
AU - Roman Günthner
AU - Claudius Küchle
AU - Michael Basta-Wunderle
AU - Bernhard Haller
AU - Uwe Heemann
AU - Christoph Schmaderer
AU - Susanne Angermann
PY - 2026
DA - 2026/10/07
JO - Clinical kidney journal
DO - 10.1093/ckj/sfag340
UR - https://europepmc.org/article/PMC/PMC13724265
AB - 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 2-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 2-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 >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.
SN - 2048-8505
SN - 2048-8513
ER -