# Association between NPAR and cognitive impairment in peritoneal dialysis patients

## TL;DR

This study finds that a new blood marker called NPAR is linked to cognitive problems in patients on peritoneal dialysis.

## Contribution

The study identifies NPAR as a novel and independent predictor of cognitive impairment in peritoneal dialysis patients.

## Key findings

- Cognitive impairment was present in 66.45% of peritoneal dialysis patients.
- NPAR, along with age, phosphorus levels, and education, independently predicted cognitive impairment.
- Combining NPAR with other factors improved prediction accuracy for cognitive impairment.

## Abstract

The neutrophil percentage-to-albumin ratio (NPAR) is a novel inflammatory marker. This study explores its association with cognitive impairment (CI) in peritoneal dialysis (PD) patients.

In this cross-sectional study, 152 PD patients were categorized into CI (Montreal Cognitive Assessment (MoCA) score <26) or non-CI (MoCA ≥26) groups.

CI was present in 66.45% of PD patients. Patients in the CI group had older age (63.01 ± 10.88 vs. 49.75 ± 12.74 years, p < 0.001), a high proportion of female individuals (43.56% vs. 23.53%, p = 0.016), and a higher NPAR (1.94 ± 0.24 vs. 1.80 ± 0.24, p = 0.001). In addition, patients in the CI group had lower levels of education (8.24 ± 2.97 vs. 11.55 ± 3.45 years, p < 0.001), serum albumin (36.29 ± 3.56 vs. 37.75 ± 2.60 g/L, p = 0.010), potassium (4.30 ± 0.71 vs. 4.51 ± 0.53 mmol/L, p = 0.039), creatinine (865.79 ± 274.38 vs. 1099.92 ± 293.86 umol/L, p < 0.001), and phosphorus (1.43 ± 0.41 vs. 1.68 ± 0.44 mmol/L, p = 0.001). Multivariate logistic regression analysis revealed that NPAR, age, serum phosphorus levels, and education were significant independent determinants of CI. The area under the curve (AUC) for NPAR in predicting CI was 0.657, with a sensitivity of 0.496 and a specificity of 0.745 (p = 0.002). When age, NPAR, blood phosphorus levels, and education were combined, the AUC increased to 0.861, with a sensitivity of 0.822 and specificity of 0.745 (p < 0.001).

CI in PD patients was found to be independently associated with elevated NPAR. The NPAR may serve as a potential biological indicator for identifying prevalent cases of CI, providing a basis for further exploration of early intervention strategies for CI.