Cognitive Impairment and Progression of CKD

doi:10.1053/j.ajkd.2016.01.026

Observational Study

. 2016 Jul;68(1):77-83.

doi: 10.1053/j.ajkd.2016.01.026. Epub 2016 Mar 10.

Cognitive Impairment and Progression of CKD

Collaborators, Affiliations

Collaborators

Chronic Renal Insufficiency Cohort (CRIC) Study Investigators:
Lawrence J Appel, Harold I Feldman, Alan S Go, Jiang He, John W Kusek, James P Lash, Akinlolu Ojo, Mahboob Rahman, Raymond R Townsend

Affiliations

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.

PMID: 26972681
PMCID: PMC4921255
DOI: 10.1053/j.ajkd.2016.01.026

Observational Study

Cognitive Impairment and Progression of CKD

Manjula Kurella Tamura et al. Am J Kidney Dis. 2016 Jul.

. 2016 Jul;68(1):77-83.

doi: 10.1053/j.ajkd.2016.01.026. Epub 2016 Mar 10.

Collaborators

Chronic Renal Insufficiency Cohort (CRIC) Study Investigators:
Lawrence J Appel, Harold I Feldman, Alan S Go, Jiang He, John W Kusek, James P Lash, Akinlolu Ojo, Mahboob Rahman, Raymond R Townsend

Affiliations

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.

PMID: 26972681
PMCID: PMC4921255
DOI: 10.1053/j.ajkd.2016.01.026

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.

Keywords: CRIC (Chronic Renal Insufficiency Cohort); Cognitive impairment; Modified Mini-Mental State Exam (3MS); attention; chronic kidney disease (CKD); cognitive function testing; concentration; disease progression; end-stage renal disease (ESRD); impaired cognitive function; memory; microvascular disease; renal function.

Published by Elsevier Inc.

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References

1. Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, Allman RM, Warnock DG, McClellan W. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008 Aug;52(2):227–234. - PMC - PubMed
1. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27;348(13):1215–1222. - PubMed
1. Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, Wolf PA, DeCarli C. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology. 2011 Aug 2;77(5):461–468. - PMC - PubMed
1. Martinez-Vea A, Salvado E, Bardaji A, Gutierrez C, Ramos A, Garcia C, Compte T, Peralta C, Broch M, Pastor R, Angelet P, Marcas L, Sauri A, Oliver JA. Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD. Am J Kidney Dis. 2006 Feb;47(2):241–250. - PubMed
1. Khatri M, Wright CB, Nickolas TL, Yoshita M, Paik MC, Kranwinkel G, Sacco RL, DeCarli C. Chronic kidney disease is associated with white matter hyperintensity volume: the Northern Manhattan Study (NOMAS) Stroke. 2007 Dec;38(12):3121–3126. - PMC - PubMed

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[1] Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, Allman RM, Warnock DG, McClellan W. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008 Aug;52(2):227–234. - PMC - PubMed

[2] Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, Allman RM, Warnock DG, McClellan W. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008 Aug;52(2):227–234. - PMC - PubMed

[3] Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27;348(13):1215–1222. - PubMed

[4] Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003 Mar 27;348(13):1215–1222. - PubMed

[5] Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, Wolf PA, DeCarli C. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology. 2011 Aug 2;77(5):461–468. - PMC - PubMed

[6] Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, Wolf PA, DeCarli C. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology. 2011 Aug 2;77(5):461–468. - PMC - PubMed

[7] Martinez-Vea A, Salvado E, Bardaji A, Gutierrez C, Ramos A, Garcia C, Compte T, Peralta C, Broch M, Pastor R, Angelet P, Marcas L, Sauri A, Oliver JA. Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD. Am J Kidney Dis. 2006 Feb;47(2):241–250. - PubMed

[8] Martinez-Vea A, Salvado E, Bardaji A, Gutierrez C, Ramos A, Garcia C, Compte T, Peralta C, Broch M, Pastor R, Angelet P, Marcas L, Sauri A, Oliver JA. Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD. Am J Kidney Dis. 2006 Feb;47(2):241–250. - PubMed

[9] Khatri M, Wright CB, Nickolas TL, Yoshita M, Paik MC, Kranwinkel G, Sacco RL, DeCarli C. Chronic kidney disease is associated with white matter hyperintensity volume: the Northern Manhattan Study (NOMAS) Stroke. 2007 Dec;38(12):3121–3126. - PMC - PubMed

[10] Khatri M, Wright CB, Nickolas TL, Yoshita M, Paik MC, Kranwinkel G, Sacco RL, DeCarli C. Chronic kidney disease is associated with white matter hyperintensity volume: the Northern Manhattan Study (NOMAS) Stroke. 2007 Dec;38(12):3121–3126. - PMC - PubMed

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Cognitive Impairment and Progression of CKD

Collaborators

Affiliations

Cognitive Impairment and Progression of CKD

Authors

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Abstract

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