Abstract: Objective To explore the influencing factors for cognitive impairment (CI) in patients with maintenance hemodialysis (MHD).  Methods The MHD patients in the Blood Purification Center of Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University from March to May 2023 were selected as the study subjects by convenient sampling method. Patients were divided into CI group (68 cases) and non-CI group (131 cases) according to the score of the Montreal Basic Cognitive Assessment Scale. General information, dialysis data, laboratory results, comorbidities, sleep status and Ishii score were collected. The influencing factors for CI were analyzed by logistic regression. The predictive value of Ishii score on CI was evaluated by using the receiver operating characteristic (ROC) curve.  Results  A total of 199 MHD patients were included in this study, and 34.2% of the patients had CI. Binary logistic regression showed that older age, higher Ishii score, higher cholesterol level, poor sleep status and lower education level were the independent risk factors for CI (OR=7.694, 3.259, 1.567, 1.085 and 0.318, respectively; 95% CI:2.484～23.830, 1.417～7.494, 1.084～2.265, 1.016～1.159 and 0.148～0.684, respectively; P<0.001, 0.005, 0.017, 0.015 and 0.003, respectively). Further study on the ROC curve of Ishii score showed that the optimal critical values for predicting CI in MHD patients, male and female MHD patients were 98.03, 105.17 and 125.49 points, respectively; the areas under the curve were 0.809, 0.813 and 0.802, respectively; the sensitivities were 85.30%, 80.00%, 68.40%, respectively and the specificities were 63.40%, 72.60%, 79.30%, respectively (P<0.001).  Conclusions  The prevalence of CI in MHD patients is higher. CI is affected by many factors. High Ishii score is an independent risk factor for CI, and is a useful indicator for the prediction of CI in MHD patients.

Key words: Hemodialysis, Cognitive impairment, Influencing factors, Ishii score