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Albuminuria and cognitive decline in people with diabetes and normal renal function.
Clin J Am Soc Nephrol. 2013 Nov; 8(11):1907-14.CJ

Abstract

BACKGROUND AND OBJECTIVES

Diabetes mellitus is associated with increased risk of cognitive impairment. This study examines whether microvascular disease, as measured by albuminuria and decline in estimated GFR (eGFR), is associated with cognitive decline during 3.3 years of follow-up in individuals with diabetes with a normal baseline eGFR (approximately 90 ml/min per 1.73 m(2)).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Participants were from the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes study (N=2977; mean age 62.5 ± 5.8 years; recruitment from August 2003 to December 2005, followed through June 2009), which examined the association of intensive versus standard glucose control on cognitive function. Participants underwent three neuropsychologic tests at baseline, 20 months, and 40 months. Tests included information processing speed, verbal memory, and executive function. Mixed-effects models were used to assess the association of albuminuria and eGFR on the percentage decline in each test.

RESULTS

Participants with albuminuria at baseline and follow-up (persistent albuminuria) (-5.8% [95% confidence interval (CI), -7.3 to -4.2]) and participants with albuminuria at follow-up but none at baseline (progressive albuminuria) (-4.1% [95% CI, -5.6 to -2.7]) had greater percentage declines on information processing speed than participants without albuminuria at baseline and at follow-up (no albuminuria) (-2.6% [95% CI, -3.4 to -1.9]) (P=0.001 and P=0.10, respectively). There were borderline percentage changes in the test of verbal memory (4.8% [95% CI, 2.4 to 7.1] and 4.7% [95% CI, 2.5 to 7.0] versus 7.1% [95% CI, 6.0 to 8.3]; P=0.11 and P=0.08, respectively). On logistic regression analysis, persistent albuminuria (odds ratio, 1.37 [95% CI, 1.09 to 1.72]) and progressive albuminuria (odds ratio, 1.25 [95% CI, 1.02 to 1.56]) were associated with a ≥ 5% decline in information processing speed scores but not with verbal memory or executive function performance. A 1 ml/min per 1.73 m(2) per year eGFR decline had a borderline association with decline in tests of cognitive function.

CONCLUSIONS

Persistent albuminuria and progressive albuminuria are associated with a decline in cognitive function in relatively young individuals with diabetes with unimpaired eGFR. These findings do not rule out the possibility of other processes causing cognitive decline.

Authors+Show Affiliations

Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

23990163

Citation

Barzilay, Joshua I., et al. "Albuminuria and Cognitive Decline in People With Diabetes and Normal Renal Function." Clinical Journal of the American Society of Nephrology : CJASN, vol. 8, no. 11, 2013, pp. 1907-14.
Barzilay JI, Lovato JF, Murray AM, et al. Albuminuria and cognitive decline in people with diabetes and normal renal function. Clin J Am Soc Nephrol. 2013;8(11):1907-14.
Barzilay, J. I., Lovato, J. F., Murray, A. M., Williamson, J., Ismail-Beigi, F., Karl, D., Papademetriou, V., & Launer, L. J. (2013). Albuminuria and cognitive decline in people with diabetes and normal renal function. Clinical Journal of the American Society of Nephrology : CJASN, 8(11), 1907-14. https://doi.org/10.2215/CJN.11321112
Barzilay JI, et al. Albuminuria and Cognitive Decline in People With Diabetes and Normal Renal Function. Clin J Am Soc Nephrol. 2013;8(11):1907-14. PubMed PMID: 23990163.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Albuminuria and cognitive decline in people with diabetes and normal renal function. AU - Barzilay,Joshua I, AU - Lovato,James F, AU - Murray,Anne M, AU - Williamson,Jeff, AU - Ismail-Beigi,Faramaz, AU - Karl,Diane, AU - Papademetriou,Vasilios, AU - Launer,Lenore J, Y1 - 2013/08/29/ PY - 2013/8/31/entrez PY - 2013/8/31/pubmed PY - 2014/7/2/medline SP - 1907 EP - 14 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 8 IS - 11 N2 - BACKGROUND AND OBJECTIVES: Diabetes mellitus is associated with increased risk of cognitive impairment. This study examines whether microvascular disease, as measured by albuminuria and decline in estimated GFR (eGFR), is associated with cognitive decline during 3.3 years of follow-up in individuals with diabetes with a normal baseline eGFR (approximately 90 ml/min per 1.73 m(2)). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Participants were from the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes study (N=2977; mean age 62.5 ± 5.8 years; recruitment from August 2003 to December 2005, followed through June 2009), which examined the association of intensive versus standard glucose control on cognitive function. Participants underwent three neuropsychologic tests at baseline, 20 months, and 40 months. Tests included information processing speed, verbal memory, and executive function. Mixed-effects models were used to assess the association of albuminuria and eGFR on the percentage decline in each test. RESULTS: Participants with albuminuria at baseline and follow-up (persistent albuminuria) (-5.8% [95% confidence interval (CI), -7.3 to -4.2]) and participants with albuminuria at follow-up but none at baseline (progressive albuminuria) (-4.1% [95% CI, -5.6 to -2.7]) had greater percentage declines on information processing speed than participants without albuminuria at baseline and at follow-up (no albuminuria) (-2.6% [95% CI, -3.4 to -1.9]) (P=0.001 and P=0.10, respectively). There were borderline percentage changes in the test of verbal memory (4.8% [95% CI, 2.4 to 7.1] and 4.7% [95% CI, 2.5 to 7.0] versus 7.1% [95% CI, 6.0 to 8.3]; P=0.11 and P=0.08, respectively). On logistic regression analysis, persistent albuminuria (odds ratio, 1.37 [95% CI, 1.09 to 1.72]) and progressive albuminuria (odds ratio, 1.25 [95% CI, 1.02 to 1.56]) were associated with a ≥ 5% decline in information processing speed scores but not with verbal memory or executive function performance. A 1 ml/min per 1.73 m(2) per year eGFR decline had a borderline association with decline in tests of cognitive function. CONCLUSIONS: Persistent albuminuria and progressive albuminuria are associated with a decline in cognitive function in relatively young individuals with diabetes with unimpaired eGFR. These findings do not rule out the possibility of other processes causing cognitive decline. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/23990163/Albuminuria_and_cognitive_decline_in_people_with_diabetes_and_normal_renal_function_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=23990163 DB - PRIME DP - Unbound Medicine ER -