A pilot study of thiamin and folic acid in hemodialysis patients with cognitive impairment

Figures & data

Figure 1. Patient inclusion and exclusion criteria.

Table 1. Comparison of baseline data between the treatment group and the control group.

	Treatment group (n = 25)	Control group (n = 25)	p Value
Age, years	66.16 ± 7.61	69.00 ± 10.80	0.287
Male, n (%)	18 (72)	19 (76)	0.747
History of smoking, n (%)	14 (56)	12 (48)	0.571
History of alcoholism, n (%)	11 (44)	7 (28)	0.239
History of drug abuse, n (%)	2 (8)	0 (0)	0.470
Education status (≥12 years, n [%])	11 (44)	14 (56)	0.369
Family history of CI, n(%)	1 (4)	0 (0)	1.000
Primary cause of MHD, n (%)
Primary glomerulonephritis	5 (20)	7 (28)	0.508
Diabetic nephropathy	5 (20)	1 (4)	0.192
Hypertensive nephrosclerosis	3 (12)	6 (24)	0.462
ADPKD	1 (4)	1 (4)	1.000
Others	3 (12)	2 (8)	1.000
Unknown cause	8 (32)	8 (32)	1.000
Complication, n (%)
Hypertension	24 (96)	23 (92)	1.000
Diabetes	9 (36)	5 (20)	0.208
Cardiovascular disease	8 (32)	5 (20)	0.333
Cerebrovascular disease	5 (20)	4 (16)	1.000
Cirrhosis	0 (0)	0 (0)	1.000
Chronic obstructive pulmonary disease	1 (4)	0 (0)	1.000
Urine, mL/day	0 (0,150)	0 (0,0)	0.230
Dialysis vintage, months	82.60 ± 51.90	107.40 ± 72.40	0.169
Dialysis duration (h/session)	4.00 ± 0.00	4.02 ± 0.10	0.322
Dialysis frequencies (time/week)	2.96 ± 0.20	2.92 ± 0.28	0.561
Intradialytic hypotension (patients, %)	13 (52)	12 (48)	0.777
Hb (g/L)	113.63 ± 15.54	112.59 ± 13.53	0.812
ALT (U/L)	11.13 ± 4.53	14.03 ± 7.97	0.131
AST (U/L)	12.42 ± 4.45	15.86 ± 6.89	0.054
TP (g/L)	72.14 ± 6.21	71.71 ± 5.02	0.797
Alb (g/L)	39.97 ± 2.02	39.47 ± 3.06	0.514
PH	7.28 ± 0.05	7.33 ± 0.04	0.000
HCO3^− (mmol/L)	18.39 ± 2.41	20.28 ± 2.23	0.009
K^+ (mmol/L)	4.76 ± 0.86	4.50 ± 0.56	0.222
Na^+ (mmol/L)	136.92 ± 3.30	136.82 ± 3.62	0.923
Ca (mmol/L)	2.25 ± 0.24	2.32 ± 0.21	0.293
P (mmol/L)	2.08 ± 0.63	1.57 ± 0.51	0.005
TC (mmol/L)	4.09 ± 0.96	3.83 ± 1.01	0.379
TG (mmol/L)	2.31 ± 1.39	2.07 ± 1.32	0.550
iPTH (pg/ml)	303.00 ± 212.08	215.04 ± 179.15	0.141
Glu (mmol/L)	6.15 ± 2.27	5.69 ± 52.27	0.496
CRP (mg/dl)	2.32 (1.12,5.13)	4.26 (1.77,7.77)	0.094
β2-MG (mg/L)	10.25 (7.58,12.05)	12.00 (8.20,43.40)	0.385
BNP (pg/ml)	219.50 (95.25,375.00)	198.50 (100.00,383.00)	0.809
spKt/V	1.58 ± 0.25	1.69 ± 0.11	0.063
Thiamin (nmol/L)	53.29 ± 7.12	52.79 ± 8.57	0.831
folic acid (ng/mL)	7.96 ± 2.10	8.77 ± 4.05	0.389
Homocysteine (μmol/L)	43.92 ± 21.05	46.82 ± 23.79	0.663
MoCA	22.08 ± 3.59	20.12 ± 4.02	0.076

Notes: The definition of drug abuse is drug dependence, no matter how much, such as sleeping pills.

Table 2. Comparison of MoCA scores, serum thiamin, folic acid and homocysteine in the control and treatment group at baseline, 48 weeks and 96 weeks of follow-up.

	Treatment group (n = 22)	Control group (n = 16)	p Value
MoCA
Baseline	21.95 ± 3.81	20.69 ± 3.40	0.297
48 weeks	25.68 ± 2.40	20.00 ± 3.95	<0.001
96 weeks	25.68 ± 1.96	19.63 ± 3.58	<0.001
Comparison between 96 weeks and baseline, p value	<0.001	0.657
Treatment difference over time, p value	<0.001	0.304
Thiamin (nmol/L)
Baseline	53.63 ± 7.33	51.98 ± 10.13	0.563
48 weeks	57.79 ± 6.09	54.90 ± 6.28	0.163
96 weeks	57.60 ± 5.86	52.87 ± 4.45	0.011
Comparison between 96 weeks and baseline, p value	0.168	1.000
Treatment difference over time, p value	0.063	0.499
Folic acid (ng/mL)
Baseline	7.88 ± 2.18	8.39 ± 2.63	0.519
48 weeks	21.94 ± 4.85	8.09 ± 4.62	<0.001
96 weeks	18.35 ± 7.94	7.3 ± 4.83	<0.001
Comparison between 96 weeks and baseline, p value	<0.001	0.870
Treatment difference over time, p value	<0.001	0.719
Homocysteine (μmol/L)
Baseline	43.55 ± 21.81	48.72 ± 27.43	0.522
48 weeks	33.64 ± 13.04	41.36 ± 13.34	0.083
96 weeks	32.58 ± 13.42	45.69 ± 18.54	0.016
Comparison between 96 weeks and baseline, p value	0.111	1.000
Treatment difference over time, p value	0.063	0.594

Notes: The normal range for blood thiamin concentration is approximately 70–180 nmol/L [18] and the normal range for serum levels of folate acid is approximately 2.7–17 ng/ml [19] in the general population.

Figure 2. The Kaplan–Meier patient survival analysis between the treatment group and the control group (p = 0.048).

Table 3. Comparison of major causes of death between treatment group and control group.

	Treatment group (n = 3)	Control group (n = 9)
Cardiovascular and cerebrovascular events, n (%)	1 (33.3%)	8 (88.9%)
Malignant tumor, n (%)	2 (66.7%)	0 (0%)
Infection, n (%)	0 (0%)	1 (11.1%)

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Data availability statement

The data analyzed in the current study are available from the corresponding author on reasonable request. Raw data retained at the Clinical Center for Investigation, Renji Hospital (RJDBLK2020-03-N13001).