BACKGROUND AND OBJECTIVES: Cognitive function worsens as kidney function declines, but mechanisms contributing to this association are not completely understood. Metabolic acidosis, a common complication of CKD, leads to neural networks overexcitation and is involved in cerebral autoregulation. We aimed to evaluate the association between serum bicarbonate concentration as a measure of metabolic acidosis, and cognitive function in hypertensive adults with and without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Five cognitive summary scores were measured (global cognitive function, executive function, memory, attention/concentration, and language) in 2853 participants in the Systolic BP Intervention Trial (SPRINT). Multivariable linear regression models adjusted for demographics, comorbidities, systolic BP, medications, eGFR and albuminuria evaluated the cross-sectional association between bicarbonate and cognition at SPRINT baseline. In a subset (n=681) who underwent brain magnetic resonance imaging, the models were adjusted for white matter hyperintensity volume, vascular reactivity, and cerebral blood flow. RESULTS: The mean age (SD) was 68 (8.5) years. Global cognitive and executive functions were positively associated with serum bicarbonate (estimate [SEM]: 0.014 [0.006]; P=0.01, and 0.018 [0.006]; P=0.003, respectively). Each 1 mEq/L lower bicarbonate level had a similar association with global cognitive and executive function as being 4.3 and 5.4 months older, respectively. The association with global cognition persisted after magnetic resonance imaging findings adjustment (estimate [SEM]: 0.03 [0.01]; P=0.01). There was no association between serum bicarbonate level and memory, attention/concentration, and language. CONCLUSIONS: In a large cohort of hypertensive adults, higher serum bicarbonate levels were independently associated with better global cognitive and executive performance. (ClinicalTrials.gov: NCT01206062).
BACKGROUND AND OBJECTIVES: Cognitive function worsens as kidney function declines, but mechanisms contributing to this association are not completely understood. Metabolic acidosis, a common complication of CKD, leads to neural networks overexcitation and is involved in cerebral autoregulation. We aimed to evaluate the association between serum bicarbonate concentration as a measure of metabolic acidosis, and cognitive function in hypertensive adults with and without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Five cognitive summary scores were measured (global cognitive function, executive function, memory, attention/concentration, and language) in 2853 participants in the Systolic BP Intervention Trial (SPRINT). Multivariable linear regression models adjusted for demographics, comorbidities, systolic BP, medications, eGFR and albuminuria evaluated the cross-sectional association between bicarbonate and cognition at SPRINT baseline. In a subset (n=681) who underwent brain magnetic resonance imaging, the models were adjusted for white matter hyperintensity volume, vascular reactivity, and cerebral blood flow. RESULTS: The mean age (SD) was 68 (8.5) years. Global cognitive and executive functions were positively associated with serum bicarbonate (estimate [SEM]: 0.014 [0.006]; P=0.01, and 0.018 [0.006]; P=0.003, respectively). Each 1 mEq/L lower bicarbonate level had a similar association with global cognitive and executive function as being 4.3 and 5.4 months older, respectively. The association with global cognition persisted after magnetic resonance imaging findings adjustment (estimate [SEM]: 0.03 [0.01]; P=0.01). There was no association between serum bicarbonate level and memory, attention/concentration, and language. CONCLUSIONS: In a large cohort of hypertensive adults, higher serum bicarbonate levels were independently associated with better global cognitive and executive performance. (ClinicalTrials.gov: NCT01206062).
Authors: Ze Wang; Geoffrey K Aguirre; Hengyi Rao; Jiongjiong Wang; María A Fernández-Seara; Anna R Childress; John A Detre Journal: Magn Reson Imaging Date: 2007-09-10 Impact factor: 2.546
Authors: Sankar D Navaneethan; Jesse D Schold; Susana Arrigain; Stacey E Jolly; Edgard Wehbe; Rupesh Raina; James F Simon; Titte R Srinivas; Anil Jain; Martin J Schreiber; Joseph V Nally Journal: Clin J Am Soc Nephrol Date: 2011-09-01 Impact factor: 8.237
Authors: Mirela Dobre; Wei Yang; Jing Chen; Paul Drawz; L Lee Hamm; Edward Horwitz; Thomas Hostetter; Bernard Jaar; Claudia M Lora; Lisa Nessel; Akinlolu Ojo; Julia Scialla; Susan Steigerwalt; Valerie Teal; Myles Wolf; Mahboob Rahman Journal: Am J Kidney Dis Date: 2013-03-13 Impact factor: 8.860
Authors: Kalani L Raphael; Rachel A Murphy; Michael G Shlipak; Suzanne Satterfield; Hunter K Huston; Anthony Sebastian; Deborah E Sellmeyer; Kushang V Patel; Anne B Newman; Mark J Sarnak; Joachim H Ix; Linda F Fried Journal: Clin J Am Soc Nephrol Date: 2016-01-14 Impact factor: 8.237
Authors: Anne M Murray; Yelena Slinin; David E Tupper; Sarah L Pederson; Cynthia Davey; David T Gilbertson; Paul Drawz; Ryan Mello; Allyson Hart; Kirsten L Johansen; Scott Reule; Rebecca Rossom; David S Knopman Journal: Am J Nephrol Date: 2022-04-28 Impact factor: 4.605
Authors: Lyndsay A Harshman; Amy J Kogon; Matthew B Matheson; Rebecca J Johnson; Shlomo Shinnar; Arlene C Gerson; Bradley A Warady; Susan L Furth; Stephen R Hooper; Marc B Lande Journal: Pediatr Nephrol Date: 2020-04-15 Impact factor: 3.714
Authors: Pedro H Imenez Silva; Robert Unwin; Ewout J Hoorn; Alberto Ortiz; Francesco Trepiccione; Rikke Nielsen; Vesna Pesic; Gaye Hafez; Denis Fouque; Ziad A Massy; Chris I De Zeeuw; Giovambattista Capasso; Carsten A Wagner Journal: Nephrol Dial Transplant Date: 2021-12-28 Impact factor: 5.992