Analysis of Characteristics of Patients on Maintenance Hemodialysis and Subjective Cognitive Decline Based on Intestinal Flora

Background: To study the relationship between intestinal flora and subjective cognitive decline (SCD) in patients with maintenance hemodialysis (MHD). Methods: From July 2022 to July 2023,84 patients with MHD in the department of severe renal disease and blood purification, first affiliated hospital of the Xi'an Jiaotong University were enrolled, the subjects were divided into SCD Group (SCD group, N = 40, MMSE score≥24 and SCD-Q9 score≥5) and normal cognition group (NC Group, N = 44, MMSE score≥24) , to investigate whether SCD is related to flora disturbance, the difference of flora at family and genus level was judged and the difference of KEGG function was predicted based on 16srDNA. Results: SCD-Q9 score in SCD Group was significantly higher than that in NC Group (P < 0.05). There were 11 different bacterial families in the SCD Group, and Erysipelatoclostridiaceae and Enterobacteriaceae had higher relative abundance in the SCD group. Among the 9 major differential bacteria, the highest relative abundance in SCD group was in Escherichia-Shigella, Ruminococcus gnavus and erysipelato-clostridium, and the positive correlation between Escherichia-Shigella and SCD-Q9 was the strongest (P < 0.01) , and the negative correlation between Escherichia-Shigella and MMSE was the strongest (P < 0.01). Ruminococcaceae had the strongest negative correlation with SCD-Q9(P < 0.01) and Faecalibacterium had the strongest positive correlation with MMSE (P < 0.01). Rikenellaceae, Marinifilaceae, Alistipes, Ruminococcus gnavus and Odoribacter were more effective in identifying SCD. Compared with NC group, SCD increased bacterial invasion, Shigella and p-nitrotoluene degradation in epithelial cells, down-regulated the biosynthesis, Nonribosomal peptide structure, and biosynthetic function of neomycin, kanamycins and gentamicin Prodigiosin, it is suggested that the dysbacteriosis of SCD may lead to the increase of pathogenic metabolic pathway and the decrease of healthy metabolic function. Conclusion: The results of this study suggest that the cognitive function of MHD patients has been altered during SCD, which is characterized by a decrease in the abundance of beneficial anti-inflammatory bacteria and an increase in the abundance of certain harmful pro-inflammatory bacteria, which indicates that intestinal flora disturbance is related to SCD and may predict SCD and become a target of intervention.