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Low 25-hydroxyvitamin D levels and cognitive impairment in hemodialysis patients.

Abstract

BACKGROUND AND OBJECTIVES

25-hydroxyvitamin D (25[OH]D) deficiency and cognitive impairment are both prevalent in hemodialysis patients in the United States. This study tested the hypothesis that 25(OH)D deficiency may be associated with cognitive impairment because of its vasculoprotective, neuroprotective, and immune-modulatory properties.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This cross-sectional analysis involved 255 patients enrolled in the Dialysis and Cognition Study between 2004 and 2012. In linear regression models, 25(OH)D was the exposure variable; it was used first as a continuous variable and then stratified as deficient (<12 ng/ml), insufficient (12 to <20 ng/ml), and sufficient (≥20 ng/ml). Principal component analysis was used to obtain the memory and the executive function domains from the individual neurocognitive tests. Scores on individual tests as well as on the memory and executive function domains were the outcome variables. Multivariable models were adjusted for age, sex, race, education, and other potential confounding variables.

RESULTS

Mean serum 25(OH)D ± SD was 17.2±7.4 ng/ml, with 14%, 55%, and 31% of patients in the deficient, insufficient, and sufficient groups, respectively. Patients in the deficient group were more likely to be women, African American, and diabetic and to have longer dialysis vintage. Higher 25(OH)D levels were independently associated with better performance on several tests of executive function (mean difference on component executive score, 0.16 [95% confidence interval, 0.04-0.28; P=0.01] for each SD higher 25[OH]D). No association was seen with tests assessing memory.

CONCLUSIONS

25(OH)D deficiency in hemodialysis patients is associated with worse cognitive function, particularly in domains that assess executive function.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts 02111, USA.

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    Source

    MeSH

    Aged
    Aged, 80 and over
    Biomarkers
    Boston
    Cognition
    Cognition Disorders
    Cross-Sectional Studies
    Executive Function
    Female
    Humans
    Linear Models
    Male
    Memory
    Middle Aged
    Multivariate Analysis
    Neuropsychological Tests
    Prevalence
    Principal Component Analysis
    Renal Dialysis
    Risk Factors
    Treatment Outcome
    Vitamin D
    Vitamin D Deficiency

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    23449769

    Citation

    Shaffi, Kamran, et al. "Low 25-hydroxyvitamin D Levels and Cognitive Impairment in Hemodialysis Patients." Clinical Journal of the American Society of Nephrology : CJASN, vol. 8, no. 6, 2013, pp. 979-86.
    Shaffi K, Tighiouart H, Scott T, et al. Low 25-hydroxyvitamin D levels and cognitive impairment in hemodialysis patients. Clin J Am Soc Nephrol. 2013;8(6):979-86.
    Shaffi, K., Tighiouart, H., Scott, T., Lou, K., Drew, D., Weiner, D., & Sarnak, M. (2013). Low 25-hydroxyvitamin D levels and cognitive impairment in hemodialysis patients. Clinical Journal of the American Society of Nephrology : CJASN, 8(6), pp. 979-86. doi:10.2215/CJN.10651012.
    Shaffi K, et al. Low 25-hydroxyvitamin D Levels and Cognitive Impairment in Hemodialysis Patients. Clin J Am Soc Nephrol. 2013;8(6):979-86. PubMed PMID: 23449769.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low 25-hydroxyvitamin D levels and cognitive impairment in hemodialysis patients. AU - Shaffi,Kamran, AU - Tighiouart,Hocine, AU - Scott,Tammy, AU - Lou,Kristina, AU - Drew,David, AU - Weiner,Daniel, AU - Sarnak,Mark, Y1 - 2013/02/28/ PY - 2013/3/2/entrez PY - 2013/3/2/pubmed PY - 2014/2/4/medline SP - 979 EP - 86 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 8 IS - 6 N2 - BACKGROUND AND OBJECTIVES: 25-hydroxyvitamin D (25[OH]D) deficiency and cognitive impairment are both prevalent in hemodialysis patients in the United States. This study tested the hypothesis that 25(OH)D deficiency may be associated with cognitive impairment because of its vasculoprotective, neuroprotective, and immune-modulatory properties. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This cross-sectional analysis involved 255 patients enrolled in the Dialysis and Cognition Study between 2004 and 2012. In linear regression models, 25(OH)D was the exposure variable; it was used first as a continuous variable and then stratified as deficient (<12 ng/ml), insufficient (12 to <20 ng/ml), and sufficient (≥20 ng/ml). Principal component analysis was used to obtain the memory and the executive function domains from the individual neurocognitive tests. Scores on individual tests as well as on the memory and executive function domains were the outcome variables. Multivariable models were adjusted for age, sex, race, education, and other potential confounding variables. RESULTS: Mean serum 25(OH)D ± SD was 17.2±7.4 ng/ml, with 14%, 55%, and 31% of patients in the deficient, insufficient, and sufficient groups, respectively. Patients in the deficient group were more likely to be women, African American, and diabetic and to have longer dialysis vintage. Higher 25(OH)D levels were independently associated with better performance on several tests of executive function (mean difference on component executive score, 0.16 [95% confidence interval, 0.04-0.28; P=0.01] for each SD higher 25[OH]D). No association was seen with tests assessing memory. CONCLUSIONS: 25(OH)D deficiency in hemodialysis patients is associated with worse cognitive function, particularly in domains that assess executive function. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/23449769/Low_25_hydroxyvitamin_D_levels_and_cognitive_impairment_in_hemodialysis_patients_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=23449769 DB - PRIME DP - Unbound Medicine ER -