The relationship between cognitive impairment and fatty acids and carnitine in hemodialysis patients


NEFROLOGIA, vol.44, no.1, pp.40-49, 2024 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 44 Issue: 1
  • Publication Date: 2024
  • Doi Number: 10.1016/j.nefro.2022.02.006
  • Journal Name: NEFROLOGIA
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE, Directory of Open Access Journals, DIALNET
  • Page Numbers: pp.40-49
  • Eskisehir Osmangazi University Affiliated: Yes


Background/Aim: The prevalence of cognitive impairment (CI) is high in hemodialysis patients. In this study, the relationship between CI and serum carnitine, plasma omega -3, omega -6 and omega-3/omega-6 fatty acid ratio was evaluated in hemodialysis patients. Materials and methods: Sixty two patients [male: 40 (64.5%), mean age 51 +13 years] were included in this cross-sectional study. Serum total and free-carnitine levels were determined by ELISA. Plasma omega -3 [eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)] and omega -6 [arachidonic acid (AA), dihomo gamma linoleic acid (DGLA)] levels were measured using LC-ESI-MS/MS. According to the Montreal Cognitive Assessment (MoCA) scores, <= 24 points were considered as CI. MoCA score <24 and >24 were determined as Group 1 and Group 2, respectively. Results: Group 1 had significantly higher AA + DGLA/EPA + DHA ratios and lower freecarnitine, DHA and EPA + DHA levels compared to Group 2 (P = 0.008, P = 0.040, P = 0.032, P = 0.032, respectively). Group 1 had a statistically lower education level (P < 0.05). Negative correlation was found between MoCA scores and AA + DGLA/EPA + DHA ratios (rs = -0.284, P = 0.026). Free-carnitine levels were positively correlated with EPA and EPA + DHA levels (rs = 0.278, P = 0.030 and rs = 0.271, P = 0.034, respectively), and negative correlated with AA + DGLA/EPA + DHA ratios (rs = -0.414, P = 0.001). In multivariate logistic regression analysis, MoCA scores was associated with AA + DGLA/EPA + DHA ratio (P = 0.009) and education level (P < 0.001). Conclusion: It was determined that high AA + DGLA/EPA + DHA ratio and low education level could be independent risk factors of the CI. It has been shown that free-carnitine level can have positive effects on plasma EPA + DHA and AA + DGLA distributions. Low omega -3 fatty acid levels may be associated with CI in hemodialysis patients, and low carnitine level may contribute partially to this process. In addition, cognitive education programs may have an effect on preventing CI in hemodialysis patients with low education levels. (c) 2022 Sociedad Espa n similar to ola de Nefrologi ' a. Published by Elsevier Espa n similar to a, S.L.U. This is an open access article under the CC BY-NC-ND license ( by-nc-nd/4.0/).