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Cognitive Impairment and Progression of CKD.
Am J Kidney Dis. 2016 Jul; 68(1):77-83.AJ

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.

Authors+Show Affiliations

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.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.Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California; Oakland, CA.Division of Research, Kaiser Permanente Northern California; Oakland, CA.Division of Nephrology, Johns Hopkins University School of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research; Baltimore, MD.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.Tulane University School of Medicine; New Orleans, LA.Department of Medicine, University of Michigan; Ann Arbor, MI.Renaissance Renal Research Institute; Detroit, MI.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.Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.Division of Research, Kaiser Permanente Northern California; Oakland, CA.No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26972681

Citation

Kurella Tamura, Manjula, et al. "Cognitive Impairment and Progression of CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 1, 2016, pp. 77-83.
Kurella Tamura M, Yaffe K, Hsu CY, et al. Cognitive Impairment and Progression of CKD. Am J Kidney Dis. 2016;68(1):77-83.
Kurella Tamura, M., Yaffe, K., Hsu, C. Y., Yang, J., Sozio, S., Fischer, M., Chen, J., Ojo, A., DeLuca, J., Xie, D., Vittinghoff, E., & Go, A. S. (2016). Cognitive Impairment and Progression of CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(1), 77-83. https://doi.org/10.1053/j.ajkd.2016.01.026
Kurella Tamura M, et al. Cognitive Impairment and Progression of CKD. Am J Kidney Dis. 2016;68(1):77-83. PubMed PMID: 26972681.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive Impairment and Progression of CKD. AU - Kurella Tamura,Manjula, AU - Yaffe,Kristine, AU - Hsu,Chi-Yuan, AU - Yang,Jingrong, AU - Sozio,Stephen, AU - Fischer,Michael, AU - Chen,Jing, AU - Ojo,Akinlolu, AU - DeLuca,Jennifer, AU - Xie,Dawei, AU - Vittinghoff,Eric, AU - Go,Alan S, AU - ,, Y1 - 2016/03/10/ PY - 2015/07/22/received PY - 2016/01/31/accepted PY - 2016/3/15/entrez PY - 2016/3/15/pubmed PY - 2017/6/1/medline KW - CRIC (Chronic Renal Insufficiency Cohort) KW - Cognitive impairment KW - Modified Mini-Mental State Exam (3MS) KW - attention KW - chronic kidney disease (CKD) KW - cognitive function testing KW - concentration KW - disease progression KW - end-stage renal disease (ESRD) KW - impaired cognitive function KW - memory KW - microvascular disease KW - renal function SP - 77 EP - 83 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 1 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26972681/Cognitive_Impairment_and_Progression_of_CKD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)00155-4 DB - PRIME DP - Unbound Medicine ER -