Avaliação cognitiva em pacientes portadores de doença renal estádio V em hemodiálise

Abstract

INTRODUCTION: Chronic kidney disease (CKD) constitutes a major public health problem and is associated with several systemic complications, including cognitive impairment. Patients with stage V CKD undergoing hemodialysis exhibit a high prevalence of cognitive decline, which can negatively impact treatment adherence, quality of life, and mortality rates. OBJECTIVE: To evaluate the cognitive status of patients with stage V chronic kidney disease undergoing hemodialysis using the Montreal Cognitive Assessment (MoCA) and to investigate associations between cognitive performance and clinical, demographic, and laboratory characteristics. METHODS: This was a cross-sectional, observational study conducted at a satellite hemodialysis unit in Goiânia-GO. A total of 132 patients aged 18 years or older, who had been on hemodialysis for more than six months, were evaluated. Cognitive assessment was performed using the MoCA, with scores below 26 points considered indicative of impairment. Clinical, demographic, and laboratory data were retrieved from electronic medical records. Statistical analyses included association tests, Spearman's correlation, and logistic regression, with a significance level set at 5%. RESULTS: Of the 132 patients evaluated, 81 (61.4%) presented with cognitive impairment. A significant association was found between poorer cognitive performance and advanced age (p=0.003), especially in individuals aged 70 years or older. Education level also showed a significant association (p<0.001), with a higher prevalence of cognitive alterations among patients with lower educational attainment. Regarding laboratory parameters, an association was observed between cognitive impairment and higher blood glucose levels (p=0.042) and platelet counts (p=0.048). Negative correlations were also identified between the total MoCA score and blood glucose (r=-0.17; p=0.050) and platelet count (r=-0.18; p=0.042). CONCLUSION: A high prevalence of cognitive impairment was observed in patients with stage V CKD undergoing hemodialysis. Advanced age and lower education levels were significantly associated with poorer cognitive performance, while blood glucose levels and platelet counts were related to a reduction in cognitive scores. These results reinforce the importance of systematic cognitive assessment in this population, contributing to the early identification of individuals at risk and to the planning of monitoring and intervention strategies.