Factors influencing cognitive impairment in patients undergoing hemodialysis: based on health ecological model

Background and Objective: Cognitive impairment represents a prevalent issue among patients undergoing hemodialysis (HD). Nevertheless, the majority of existing studies have predominantly focused on its influencing factors from a single-dimensional perspective. This study aims to comprehensively investigate the multifaceted factors contributing to cognitive impairment in patients undergoing HD by applying the health ecological model. Method: Data of 172 patients undergoing HD from the Hemodialysis unit from a Chinese tertiary hospital were collected from June 2022 to October 2022. A total of 24 variables were collected across the five dimensions of the health ecological model. The Montreal Cognitive Assessment (MoCA) scale was used to assess cognitive function. Lasso regression was applied to screen the variables, and binary logistic regression was used to identify independent risk factors for cognitive impairment. Results: Gender, age, protein intake, and cholesterol were independently associated with cognitive impairment in patients undergoing HD. The predictive model incorporating these factors achieved a moderate goodness-of-fit (Nagelkerke R² = 0.543), reflecting their combined contribution to cognitive risk. Conclusion: Cognitive impairment is highly prevalent among Chinese patients undergong HD, influenced by factors such as aging, female sex, insufficient protein intake, and low cholesterol levels. These findings underscore the multifactorial nature of cognitive decline in patients undergoing HD within the framework of a health ecological model, highlighting the need for comprehensive interventions that address biological, behavioral, psychological, disease-related and social domains.