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May 3, 2026SHILAP Revista de lepidopterología0 citationsOpen Access

Association between protein-energy wasting and cognitive impairment in maintenance hemodialysis patients

XWXiaobao WeiXuzhou Medical College TZTing ZhangXuzhou Medical College MSMeng SunNanjing Medical University

Key Points

This research aims to explore the relationship between protein-energy wasting and cognitive impairment in patients undergoing maintenance hemodialysis.
Cross-sectional study design involving 86 maintenance hemodialysis patients from a single center.
Nutritional status assessed via anthropometric measurements and Malnutrition-Inflammation Score (MIS).
Cognitive function evaluated using the Montreal Cognitive Assessment (MoCA), with correlations and multivariable logistic regression applied.
58.1% of patients exhibited cognitive impairment, with higher Malnutrition-Inflammation Scores and lower mid-arm muscle circumferences in the cognitive impairment group.
Lower mid-arm muscle circumference was associated with cognitive impairment with an adjusted OR of 0.571 (95% CI 0.400–0.816, p = 0.002).
Higher Malnutrition-Inflammation Score showed an adjusted OR of 1.249 (95% CI 1.006–1.550, p = 0.044) linked to cognitive impairment.

Abstract

Objective This study aimed to investigate the association between protein-energy wasting (PEW) and cognitive impairment (CI) in patients undergoing maintenance hemodialysis (MHD). Methods In this single-center cross-sectional study, 86 patients receiving MHD were enrolled. Nutritional status was assessed using anthropometric measurements, including mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC), as well as the Malnutrition-Inflammation Score (MIS). Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA), with patients classified into CI (n = 50) and non-CI (n = 36) groups based on education-adjusted scores. Group comparisons, Spearman correlation analysis, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. Results Cognitive impairment was present in 58.1% of the patients. Compared with the non-CI group, patients with CI had a higher Malnutrition–Inflammation Score and lower MAMC. Multivariable logistic regression analysis showed that lower MAMC (adjusted OR 0.571, 95% CI 0.400–0.816, p = 0.002) and higher MIS (adjusted OR 1.249, 95% CI 1.006–1.550, p = 0.044) were independently associated with cognitive impairment. ROC analysis demonstrated that a multivariable model combining age, years of education, dialysis vintage, MAMC, and MIS exhibited excellent discriminative ability (AUC = 0.942, 95% CI 0.898–0.987). Conclusion Lower MAMC and higher MIS were independently associated with cognitive impairment in patients undergoing maintenance hemodialysis. These two indicators (MAMC and MIS) showed stronger and more consistent associations with cognitive impairment than single biochemical markers. Given the cross-sectional design of the study, the temporal direction of the association cannot be determined. Prospective studies are warranted to clarify whether muscle loss precedes cognitive decline or occurs as a consequence of it, and to evaluate whether preserving muscle mass can protect cognitive function in this population.

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