Déficit cognitivo em pacientes hemodialíticos e sua relação com as alterações nos marcadores sanguíneos

Abstract

Chronic kidney disease-CKD is characterized by the accumulation of toxins in the body, protein deficiency and hormonal alterations, which affect the functioning of several systems, requiring the institution of hemodialysis treatment. In this pathological condition, several factors contribute to the development of neurological disorders and may be associated with alterations in the vascular system, hematological and redox imbalance. Thus, this study aimed to evaluate the impact of changes in redox status and biochemical and hematological markers on the cognitive decline of 117 patients with CKD undergoing hemodialysis. This is an analytical cross-sectional epidemiological study in a dialysis unit of Aracaju-SE, under approval by the CEP/UFS (CAAE: 82115717.0.000.5546). Socio-demographic and dialytic data were obtained through active search in medical records. The cognitive evaluation was performed using the MMME and BBRC. Blood samples were collected for the evaluation of redox, biochemical and hematological status markers. The data tabulation was performed in Microsoft Office Excel and subsequently transferred to the Graph Pad Prism software version 7.0.3. The sample consisted mainly of males (60.7%) aged 40-59 years (45%), mixed race (46.1%), married (59.8%) and with complete elementary level (47.8%). Regarding dialysis treatment, SUS was the main paying source (59.5%), with predominance of AVF as access to therapy (73.5%) and treatment time between 1 and 5 years (53%). According to MMSE, 56.8% of patients had cognitive decline. Although there was a positive correlation between MMSE and BBRC results, it was possible to identify cognitive decline in 10.5% of patients, at mild (50.0%), moderate (37.5%) and severe (12.5%). BBRC scores decreased with age, regardless of HD time and gender. In addition, changes in learning, recognition and memory were detected. There was also a positive correlation between TBRAS (plasma) and HD time, as well as this marker of lipid damage with the learning and recognition domains. Regarding enzymatic antioxidant defenses, a positive correlation was found between superoxide dismutase SOD (erythrocytes) and immediate memory and learning. Finally, positive correlations between BBRC and ferritin levels were observed, as well as a negative correlation between total SH and GSH levels with creatinine, and a positive correlation between total SH (plasma) with albumin and hemoglobin. Thus, the results obtained indicate that chronic renal patients present cognitive alterations that may be related not only to redox imbalance but also to the hematological and biochemical alterations inherent in the pathophysiology, which seems to be aggravated by disease progression and treatment time regardless of gender. Thus, the decline in the quality of cognitive domains such as learning, recognition and memory may contribute to reducing patients' quality of life, as well as increasing the need for support for the care and management of CKD patients. Therefore, this study may contribute to further research to better understand the mechanisms by which cognitive decline affects patients with CKD, from the perspective that screening for redox status, biochemical and hematological markers can be used as an alternative method for screening for disorders neurological.