BACKGROUND
Chronic kidney disease (CKD) is one of risk factors for
dementia and
cognitive decline. Cardiovascular and dialysis-related factors might also be involved in the mechanism of
cognitive impairment in
hemodialysis patients. The objective of this study was to investigate whether cardiovascular risk factors including intracranial artery calcification and dialysis-related factors such as
fibroblast growth factor 23 (FGF23) might be associated with
cognitive impairment in
hemodialysis patients. MATERIAL AND METHODS A cross-sectional observational study included patients receiving in-center
hemodialysis over 6 months at our hospital. All patients underwent non-contrast computed tomography (CT) examinations. Internal carotid artery (ICA)
calcium scores were measured using the Agatston method. The Korean version of the Montreal Cognitive Assessment was used for measurement of cognitive function at each study visit. Serum concentrations of FGF23,
osteoprotegerin, and klotho were analyzed using commercial
enzyme-linked
immunosorbent assay kits. RESULTS This study included 69 patients.
Cognitive impairment was observed in 22 patients (31.9%), including 3 patients with
dementia. ICA
calcium score in patients with
cognitive impairment was higher than that in those without
cognitive impairment (177.3 versus 87.6, P=0.022). Intracranial artery calcification was significantly associated with
cognitive impairment after adjusting for FGF23 and 25-OH
vitamin D, but not significant after adjusting for age, FGF23, and 25-OH
vitamin D. Low level of FGF23 was associated with
cognitive impairment. CONCLUSIONS Intracranial artery calcification and low FGF23 could be associated with
cognitive impairment in
hemodialysis patients. Longitudinal studies are needed to investigate whether intracranial artery calcification and FGF23 could affect cognitive function of
hemodialysis patients.