Prevalence and Pattern of Cognitive Impairment in Patients on Maintenance Hemodialysis
Bibliographic record
Abstract
Background Despite the rising burden of end-stage renal disease (ESRD), cognitive assessment is not routinely incorporated into dialysis care, particularly in low-resource settings. This study aimed to assess the prevalence, severity, and predictors of cognitive impairment among patients on maintenance hemodialysis. Methods A descriptive cross-sectional study was conducted at a tertiary dialysis center from December 2023 to May 2024. Patients aged ≥18 years undergoing hemodialysis for six months or more were enrolled. Exclusion criteria included neurological disorders, severe psychiatric illness, or medications affecting cognition. Cognitive function was evaluated using the Urdu-validated Montreal Cognitive Assessment (MoCA), with scores <26 indicating impairment. Domain-wise deficits were classified using 1.5 standard deviation below the normative mean. Statistical analysis included chi-square tests, t-tests, and multivariable logistic regression. Results Out of 198 hemodialysis patients, 116 (58.6%) exhibited cognitive impairment. Severity was categorized as mild in 79 (39.9%), moderate in 31 (15.7%), and severe in eight (4.0%) patients. Multidomain impairment was present in 108 (54.5%), while 18 (9.1%) had single-domain and 72 (36.4%) had no impairment. Older age (p<0.001), lower education (p<0.001), low socioeconomic status (SES) (p=0.045), and longer dialysis duration (p<0.001) were significantly associated with cognitive impairment. Biochemical predictors included lower hemoglobin and albumin (p=0.018 and p=0.034), and higher phosphate and intact parathyroid hormone (iPTH) (p=0.001 and p=0.042). On regression analysis, age (adjusted odds ratio (AOR)=1.088, 95% confidence interval (CI)=1.031-1.149), education ≤12 years (AOR=10.423, 95% CI=1.199-90.633), low SES (AOR=9.075, 95% CI=1.473-55.916), dialysis duration (AOR=1.047, 95% CI=1.010-1.085), and biochemical markers remained significant. Conclusion Cognitive impairment, particularly multidomain, is highly prevalent among hemodialysis patients and frequently unrecognized. Integration of cognitive screening into routine nephrology care is essential to enable early intervention and improve long-term patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".