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

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); <i>p</i> = 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 <i>p</i> = 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.</p> <p></p><p>In maintenance hemodialysis patients with baseline MoCA scores ≥26, lower serum brain-derived neurotrophic factor was associated with a higher 1-year risk of screening-defined incident cognitive impairment.</p><p>Adding serum brain-derived neurotrophic factor to routine baseline variables produced a small and statistically uncertain improvement in discrimination (area under the curve 0.770 to 0.797; DeLong <i>p</i> = 0.236), suggesting a modest adjunctive contribution rather than stand-alone predictive value.</p><p>Serum brain-derived neurotrophic factor may have value as an adjunctive biomarker for cognitive risk stratification in maintenance hemodialysis, but independent multicenter external validation is needed before clinical use.</p><p></p> <p>In maintenance hemodialysis patients with baseline MoCA scores ≥26, lower serum brain-derived neurotrophic factor was associated with a higher 1-year risk of screening-defined incident cognitive impairment.</p> <p>Adding serum brain-derived neurotrophic factor to routine baseline variables produced a small and statistically uncertain improvement in discrimination (area under the curve 0.770 to 0.797; DeLong <i>p</i> = 0.236), suggesting a modest adjunctive contribution rather than stand-alone predictive value.</p> <p>Serum brain-derived neurotrophic factor may have value as an adjunctive biomarker for cognitive risk stratification in maintenance hemodialysis, but independent multicenter external validation is needed before clinical use.</p>