Association of brachial-ankle pulse wave velocity with cognitive impairment in peritoneal dialysis patients

Background The relationship between cognitive impairment (CI) and arterial stiffness in peritoneal dialysis (PD) patients has not been clearly clarified. The aim of this study was to examine the relationship between CI and arterial stiffness in PD patients. Methods This cross-sectional study enrolled PD patients who performed a vascular profiler test at a single PD center in China between January 2014 and June 2016. The cognitive function was evaluated using the Montreal cognitive assessment (MoCA). A noninvasive vascular screening device was used to assess arterial stiffness relevant indicators. Results A total of 643 PD patients with median age 45 (37-57.4) years and median duration of PD 27.8 (8.7-56.4) months were enrolled. The rate of CI was 49.9%. The mean brachial-ankle pulse wave velocity (baPWV) was 17.2 +/- 5.6 m/s. Compared with normal cognitive function group, patients with CI had higher baPWV (18.6 +/- 7.0 vs. 15.8 +/- 3.2 m/s), systolic blood pressure (150.3 +/- 21.5 vs. 144.2 +/- 20.2 mmHg), and pulse pressure (59.7 +/- 14.7 vs. 52.5 +/- 11.6 mmHg), and lower ankle-brachial index (ABI, 1.12 +/- 0.12 vs. 1.15 +/- 0.09) (all p<.05). Compared with systolic blood pressure, pulse pressure, and ABI in receiver operating characteristic (ROC) analysis, baPWV had better performance in predicting CI (area under curve: 0.68, 95% confidence interval: 0.64-0.72). BaPWV was independently associated with MoCA score (B per SD, -0.42 [95% confidence interval, -0.71 to -0.12]; p = .006) and CI (OR per SD, 1.55 [95% confidence interval, 1.11-2.17]; p = .011) in PD patients after adjustment for confounders. Conclusions Higher baPWV was independently associated with CI in PD patients.