Cognitive impairment (CI) is highly prevalent in patients with end-stage renal disease (ESRD) , which seriously affects the prognosis of patients. Early identification of its associated factors is of great significance, but there is no agreement as to existing relevant research conclusions, and no relevant systematic reviews conducted with Chinese patients with ESRD.

To systematically evaluate the factors associated with CI in Chinese patients with ESRD.

Databases of PubMed, Web of Science, EMBase, CNKI, WanFangData, CQVIP and CBM were searched from inception to October 2021 for studies (including cross-sectional studies, cohort studies and case-control studies) about associated factors of CI in Chinese ESRD patients (with stage CKD5 defined in the 2002 Kidney Disease Outcomes Quality Initiative, or treatment with peritoneal dialysis or hemodialysis) using subject words in combination with free words as search terms with adjustment by the database feature when necessary. Two researchers independently performed literature screening, data extraction, and methodological quality assessment. Stata 15.0 was employed for Meta-analysis.

In total, 44 studies were included, including 42 172 patients, among which, the cohort studies and case-control studies were rated as high-quality evidence, and the cross-sectional studies as moderate or high-quality evidence. Meta-analysis revealed that older age〔OR=1.17, 95%CI (1.13, 1.22) , P<0.001〕, long duration of dialysis〔OR=1.02, 95%CI (1.00, 1.03) , P=0.008〕, hypertension〔OR=2.02, 95%CI (1.06, 3.86) , P=0.032〕, stroke〔OR=1.93, 95%CI (1.33, 2.80) , P=0.001〕, diabetes〔OR=1.99, 95%CI (1.62, 2.44) , P<0.001〕, high Charlson Comorbidity Index (CCI) 〔OR=5.28, 95%CI (1.48, 18.82) , P=0.010〕, depression〔OR=2.46, 95%CI (1.61, 3.77) , P<0.001〕, high parathyroid hormone (PTH) 〔OR=1.02, 95%CI (1.00, 1.04) , P=0.034〕, high C-reactive protein (CRP) 〔OR=1.20, 95%CI (1.01, 1.42) , P=0.040〕and high Hcy 〔OR=3.34, 95%CI (2.06, 5.42) , P<0.001〕 were associated with increased risk of CI, while male〔OR=0.55, 95%CI (0.37, 0.82) , P=0.003〕, high education level〔OR=0.45, 95%CI (0.37, 0.55) , P<0.001〕, high Hb〔OR=0.91, 95%CI (0.86, 0.95) , P<0.001〕, high serum ALB〔OR=0.77, 95%CI (0.63, 0.94) , P=0.009〕 and high serum creatinine〔OR=0.997, 95%CI (0.995, 0.999) , P=0.003〕were associated with decreased risk of CI.

The current evidence proves that the risk of CI in Chinese patients with ESRD may be increased with older age, long duration of dialysis, hypertension, stroke, diabetes, high CCI, depression, high PTH, high CRP and high Hcy, and decreased with male, high education level, and high Hb, ALB and Cr. However, the conclusion needs to be verified by more high-quality studies due to limited number and quality of included studies.

认知障碍（CI）在终末期肾病（ESRD）患者中发病率较高，且严重影响患者的预后。及早识别其发生的影响因素具有重要意义，但现有研究结论尚存争议，且国内尚无相关系统综述。

系统评价中国ESRD患者CI的影响因素。

计算机检索PubMed、Web of Science、EMBase、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库，搜集有关我国ESRD患者CI影响因素的研究，检索时限均为建库至2021年10月。采用主题词与自由词相结合的方式进行检索，并根据各数据库特点进行调整。研究类型为横断面研究、队列研究或病例对照研究；研究对象为满足2002年肾脏病预后质量指南（K/DOQI）标准慢性肾脏疾病（CKD）5期的ESRD患者，或已经接受腹膜透析（PD）或者血液透析（HD）治疗的患者，且为中国人群。由2名研究者独立筛选文献，提取资料并评价纳入研究的质量后，使用Stata 15.0软件进行Meta分析。

共纳入44篇文献，包括42 172例患者。纳入的队列研究和病例对照研究均为高质量研究，横断面研究质量均在中等及以上。Meta分析结果显示，年龄高〔OR=1.17，95%CI（1.13，1.22），P<0.001〕、透析龄长〔OR=1.02，95%CI（1.00，1.03），P=0.008〕、高血压〔OR=2.02，95%CI（1.06，3.86），P=0.032〕、脑卒中〔OR=1.93，95%CI（1.33，2.80），P=0.001〕、糖尿病〔OR=1.99，95%CI（1.62，2.44），P<0.001〕、Charlson合并症指数高〔OR=5.28，95%CI（1.48，18.82），P=0.010〕、抑郁〔OR=2.46，95%CI（1.61，3.77），P<0.001〕、高甲状旁腺激素（PTH）〔OR=1.02，95%CI（1.00，1.04），P=0.034〕、高C反应蛋白（CRP）〔OR=1.20，95%CI（1.01，1.42），P=0.040〕、高同型半胱氨酸（Hcy）〔OR=3.34，95%CI（2.06，5.42），P<0.001〕均是我国ESRD患者CI的危险因素。男性〔OR=0.55，95%CI（0.37，0.82），P=0.003〕、教育程度高〔OR=0.45，95%CI（0.37，0.55），P<0.001〕、高血红蛋白（Hb）〔OR=0.91，95%CI（0.86，0.95），P<0.001〕、高血清白蛋白（ALB）〔OR=0.77，95%CI（0.63，0.94），P=0.009〕、高血清肌酐（Cr）〔OR=0.997，95%CI（0.995，0.999），P=0.003〕均是我国ESRD患者CI的保护因素。

当前证据证明，年龄高、透析龄长、高血压、脑卒中、糖尿病、Charlson合并症指数高、抑郁、高PTH、高CRP、高Hcy是ESRD患者CI的危险因素，男性、教育程度高、高Hb、高ALB、高Cr是ESRD患者CI的保护因素。受纳入研究的数量和质量的限制，上述结论尚需要更多高质量研究予以验证。