Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study |
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| Authors: | Kristine Yaffe MD Lynn Ackerson PhD Manjula Kurella Tamura MD MPH Patti Le Blanc MA John W. Kusek PhD Ashwini R. Sehgal MD Debbie Cohen MD Cheryl Anderson PhD MS Lawrence Appel MD Karen DeSalvo MD MPH Akinlolu Ojo MD PhD Stephen Seliger MD Nancy Robinson MD Gail Makos RN MSN Alan S. Go MD |
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| Affiliation: | 1. From the Departments ofaPsychiatry, bNeurology, and cEpidemiology and Biostatistics, School of Medicine, University of California at San Francisco, San Francisco, California;2. dSan Francisco Veterans Affairs Medical Center, San Francisco, California;3. eDivision of Research, Kaiser Permanente, Oakland, California;4. fDivision of Nephrology, Stanford University School of Medicine, Palo Alto, California;5. gNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;6. Departments ofhMedicine, iBiomedical Ethics, andjEpidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio;7. kDepartment of Medicine, University of Pennsylvania Medical School, Philadelphia, Pennsylvania;8. Departments oflEpidemiology, mMedicine, andnInternational Health, Johns Hopkins University, Baltimore, Maryland;9. oDepartment of Medicine, School of Medicine, Tulane University, New Orleans, Los Angeles;10. pDepartments of Internal Medicine and Nephrology, University of Michigan Medical School, Ann Arbor, Michigan;11. qDivision of Nephrology, School of Medicine, University of Maryland, Baltimore, Maryland;12. and rSt. Clair Specialty Physicians, P.C., Chronic Kidney Disease Clinic, Detroit, Michigan |
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| Abstract: | OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross‐sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty‐five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m2) was estimated using the four‐variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ≤1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1–3.9), naming (AOR=1.9, 95% CI=1.0–3.3), attention (AOR=2.4, 95% CI=1.3–4.5), executive function (AOR=2.5, 95% CI=1.9–4.4), and delayed memory (AOR=1.5, 95% CI=0.9–2.6) but not on category fluency (AOR=1.1, 95% CI=0.6–2.0) than those with mild to moderate CKD (eGFR 45–59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment. |
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| Keywords: | chronic kidney disease cognitive impairment cognitive function |
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