The impact of Naples prognostic score on cognitive impairment in hemodialysis patients-A multicenter study

Abstract

background Nutrition and inflammatory status is prevalent in hemodialysis(HD) patients, which is relates to the incident of cognitive impairment(CI). Naples prognostic score(NPS) is a comprehensive measure of patients’ inflammation and nutritional status. This study is to investigate the effect of Naples prognostic score on the risk of incident cognitive impairment in HD patients. Methods Two thousand seven hundred twenty-five HD patients were recruited and NPS score obtained based on albumin, total cholesterol(TC), lymphocytes, neutrophils, and monocytes. Cognitive function was assessed with Mini-Mental State Examination score (MMSE). Multiple Cox regression models, interactive analyses were conducted. Results Among 2725 HD patients (33.8%) experienced incident CI, the mean MMSE score was 26.87 ± 3.9. After adjusting clinical confounders, the association remained statistically significant, higher NPS was independently associated with increased rate of CI both as a continuous variable (OR = 1.106, 95% CI 1.018–1.202, p = 0.019) and as a categorized variable(OR = 1.552, 95%CI: 1.146–2.110, p = 0.015). The analysis illustrates a negative correlation between NPS and MMSE scores. This relationship was observed both as a continuous variable (β=-0.178, 95% CI -0.321 - -0.035, p = 0.015) and as a categorized variable, compared to those in the NPS 0–1 score group, those with 4 score group was associated with an additional 0.68 faster cognitive decline (p = 0.008). Further explored the relationship between NPS and the incidence of dementia, finding that NPS had higher risk of dementia with multivariate-adjusted ORs of 1.153 (95% CI 1.035–1.286, p = 0.010). Subgroup analysis showed that the effect of NPS on CI was more pronounced in male, under 65 years, low educational levels, without diabetes and Cerebrovascular disease(CVD). Except male, low education level, and non CVD, in patients who HD frequency under 3 times per week the association between NPS and dementia was more significant. Conclusions NPS was independently associated with cognitive impairment in HD patients.