Abstract: FR-PO1037
Dynamic Cognitive State Transitions in Patients on Maintenance Hemodialysis: A Multicenter Study
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Huang, Guanwen, Huashan Hospital Fudan University, Shanghai, China
- Wang, Mengjing, Huashan Hospital Fudan University, Shanghai, China
- Qian, Jing, Huashan Hospital Fudan University, Shanghai, China
- Chen, Jing, Huashan Hospital Fudan University, Shanghai, China
Background
Cognitive impairment is common in maintenance hemodialysis patients, but the progression and reversibility of cognitive states remain unclear; multi-state Markov models provide a framework to analyze their dynamics.
Methods
A prospective cohort of 267 MHD patients aged over 18 years was recruited from three Shanghai hospitals between 2020 and 2021, with follow-up cognitive assessments in 2024. Cognitive states were defined as normal cognition (NC), mild cognitive impairment (MCI), dementia, and death. Multi-state Markov models (MSM) were applied to examine dynamic transitions between cognitive states and the influence of demographic, clinical, and biomarker factors.
Results
At baseline, 118, 130, and 19 patients were NC, MCI, and dementia, respectively. Over follow-up, 52% of NC patients remained stable, 29% progressed to MCI, and 19% died. Among MCI patients, 35% remained stable, 12% reverted to NC, 5% progressed to dementia, and 49% died; 95% of dementia patients died. Transition intensities showed 0.18 (95% CI: 0.13-0.26) for NC changing to MCI and 0.09 (95% CI: 0.05–0.15) for MCI reverting to NC, indicating bidirectional transitions in MCI. Average sojourn times decreased with impairment: NC 4.74, MCI 2.98, dementia 1.09 years. Multivariate MSM indicated higher education reduced NC progression risk, older age decreased MCI recovery, hemoperfusion therapy promoted MCI reversions, and MCI progression to dementia was associated with older age and male sex, while higher education and Aβ42/Aβ40 ratio were protective.
Conclusion
Cognitive function in MHD patients shows stage-specific dynamics, with reversible MCI and high-risk dementia, influenced by education, age, sex, Aβ42/Aβ40 ratio, and dialysis modality.
Sankey diagram of cognitive state transitions in maintenance hemodialysis patients
Funding
- Government Support – Non-U.S.