Serum BDNF and cognitive risk in maintenance hemodialysis: a machine learning study.

Overview

1. The First People’s Hospital of Lianyungang, Lianyungang, Jiangsu, China
2. Lianyungang Center for Disease Control and Prevention, Lianyungang, Jiangsu, China

Abstract

Cognitive impairment is common in maintenance hemodialysis, but practical risk-assessment tools remain limited. We evaluated the association between baseline serum brain-derived neurotrophic factor (BDNF) and 1-year screening-defined incident cognitive impairment and examined whether BDNF added predictive information beyond routine clinical, laboratory, and baseline cognitive variables. This single-center prospective cohort included 130 maintenance hemodialysis patients with baseline Montreal Cognitive Assessment (MoCA) scores ≥26. The primary outcome was screening-defined incident cognitive impairment, defined as follow-up MoCA <26. Serum BDNF was measured by enzyme-linked immunosorbent assay. Five models were assessed using repeated 5-fold cross-validation; repeated nested cross-validation was added as a sensitivity analysis. During follow-up, 70 patients (53.8%) met the screening-defined outcome. Each 1-SD higher BDNF level was associated with lower odds of the outcome [adjusted OR, 0.52 (95% CI, 0.34–0.80); p = 0.003]. In the primary analysis, random forest and extreme gradient boosting (XGBoost) had AUCs of 0.798 and 0.797, respectively. Adding BDNF to the XGBoost base model changed AUC from 0.770 to 0.797 (DeLong p = 0.236), PR-AUC from 0.746 to 0.779, and Brier score from 0.190 to 0.181. In nested validation, XGBoost AUC was 0.782 (SD 0.019), while paired Base and Base + BDNF AUCs were 0.761 and 0.782, respectively. Lower BDNF was associated with the screening-defined outcome, but its added predictive value was small and statistically uncertain. Serum BDNF may therefore have value as an adjunctive marker for refining risk estimates rather than as a stand-alone predictor; independent multicenter external validation is required before clinical use.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Data

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• figshare:33948226, at figshare; found in DataCite

Data availability statement

The de-identified datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request, subject to approval by the Medical Ethics Committee of the First People’s Hospital of Lianyungang and applicable privacy regulations.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Version 3, 28 September 2026

• Funding: added Government of Jiangsu Province

Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 7 authors, 6 keywords, 17 MeSH terms, 41 references.

Cite

This paper

Tang, Q., Tian, J., Ying, X., Zhang, Y., Huo, Y., Liu, D., & Zhang, Y. (2026). Serum BDNF and cognitive risk in maintenance hemodialysis: a machine learning study. Renal failure, 48(1), 2732422. https://doi.org/10.1080/0886022x.2026.2732422

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