Manjula Kurella Tamura1, Kristine Yaffe2, Chi-Yuan Hsu3, Jingrong Yang4, Stephen Sozio5, Michael Fischer6, Jing Chen7, Akinlolu Ojo8, Jennifer DeLuca9, Dawei Xie10, Eric Vittinghoff11, Alan S Go4. 1. VA Palo Alto Geriatric Research and Education Clinical Center; Division of Nephrology, Stanford University School of Medicine; Palo Alto, CA. Electronic address: mktamura@stanford.edu. 2. Department of Psychiatry, University of California San Francisco, San Francisco, CA; Department of Neurology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. 3. Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California; Oakland, CA. 4. Division of Research, Kaiser Permanente Northern California; Oakland, CA. 5. Division of Nephrology, Johns Hopkins University School of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research; Baltimore, MD. 6. Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC and Edward Hines, Jr VA, Chicago, IL; University of Illinois Hospital and Health Sciences System, Chicago, IL. 7. Tulane University School of Medicine; New Orleans, LA. 8. Department of Medicine, University of Michigan; Ann Arbor, MI. 9. Renaissance Renal Research Institute; Detroit, MI. 10. Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA. 11. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
Abstract
BACKGROUND: Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD. STUDY DESIGN: Prospective cohort. SETTING & PARTICIPANTS: Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2). PREDICTOR: Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications. OUTCOMES: Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR. RESULTS: In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses. LIMITATIONS: Unmeasured potential confounders, single measure of cognition for younger participants. CONCLUSIONS: Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors. Published by Elsevier Inc.
BACKGROUND:Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD. STUDY DESIGN: Prospective cohort. SETTING & PARTICIPANTS: Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2). PREDICTOR: Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications. OUTCOMES: Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR. RESULTS: In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses. LIMITATIONS: Unmeasured potential confounders, single measure of cognition for younger participants. CONCLUSIONS: Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors. Published by Elsevier Inc.
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