Cognitive Impairment and Progression of CKD

Manjula Kurella Tamura, Kristine Yaffe, Chi yuan Hsu, Jingrong Yang, Stephen M Sozio, Michael Fischer, Jing Chen, Akinlolu Ojo, Jennifer DeLuca, Dawei Xie, Eric Vittinghoff, Lawrence Appel

Research output: Contribution to journalArticle

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/1.73m2. 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.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jul 22 2015

Fingerprint

Chronic Renal Insufficiency
Chronic Kidney Failure
Glomerular Filtration Rate
Disease Progression
Cognition
Cognitive Dysfunction
Cohort Studies
Demography
Prospective Studies
Kidney

Keywords

  • Attention
  • Chronic kidney disease (CKD)
  • Cognitive function testing
  • Cognitive impairment
  • Concentration
  • CRIC (Chronic Renal Insufficiency Cohort)
  • Disease progression
  • End-stage renal disease (ESRD)
  • Impaired cognitive function
  • Memory
  • Microvascular disease
  • Modified Mini-Mental State Exam (3MS)
  • Renal function

ASJC Scopus subject areas

  • Nephrology

Cite this

Cognitive Impairment and Progression of CKD. / Kurella Tamura, Manjula; Yaffe, Kristine; Hsu, Chi yuan; Yang, Jingrong; Sozio, Stephen M; Fischer, Michael; Chen, Jing; Ojo, Akinlolu; DeLuca, Jennifer; Xie, Dawei; Vittinghoff, Eric; Appel, Lawrence.

In: American Journal of Kidney Diseases, 22.07.2015.

Research output: Contribution to journalArticle

Kurella Tamura, M, Yaffe, K, Hsu, CY, Yang, J, Sozio, SM, Fischer, M, Chen, J, Ojo, A, DeLuca, J, Xie, D, Vittinghoff, E & Appel, L 2015, 'Cognitive Impairment and Progression of CKD', American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2016.01.026
Kurella Tamura, Manjula ; Yaffe, Kristine ; Hsu, Chi yuan ; Yang, Jingrong ; Sozio, Stephen M ; Fischer, Michael ; Chen, Jing ; Ojo, Akinlolu ; DeLuca, Jennifer ; Xie, Dawei ; Vittinghoff, Eric ; Appel, Lawrence. / Cognitive Impairment and Progression of CKD. In: American Journal of Kidney Diseases. 2015.
@article{e67915892ad3444f952f049951781df4,
title = "Cognitive Impairment and Progression of CKD",
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/1.73m2. 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 = "Attention, Chronic kidney disease (CKD), Cognitive function testing, Cognitive impairment, Concentration, CRIC (Chronic Renal Insufficiency Cohort), Disease progression, End-stage renal disease (ESRD), Impaired cognitive function, Memory, Microvascular disease, Modified Mini-Mental State Exam (3MS), Renal function",
author = "{Kurella Tamura}, Manjula and Kristine Yaffe and Hsu, {Chi yuan} and Jingrong Yang and Sozio, {Stephen M} and Michael Fischer and Jing Chen and Akinlolu Ojo and Jennifer DeLuca and Dawei Xie and Eric Vittinghoff and Lawrence Appel",
year = "2015",
month = "7",
day = "22",
doi = "10.1053/j.ajkd.2016.01.026",
language = "English (US)",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",

}

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 M

AU - Fischer, Michael

AU - Chen, Jing

AU - Ojo, Akinlolu

AU - DeLuca, Jennifer

AU - Xie, Dawei

AU - Vittinghoff, Eric

AU - Appel, Lawrence

PY - 2015/7/22

Y1 - 2015/7/22

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/1.73m2. 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.

AB - 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/1.73m2. 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.

KW - Attention

KW - Chronic kidney disease (CKD)

KW - Cognitive function testing

KW - Cognitive impairment

KW - Concentration

KW - CRIC (Chronic Renal Insufficiency Cohort)

KW - Disease progression

KW - End-stage renal disease (ESRD)

KW - Impaired cognitive function

KW - Memory

KW - Microvascular disease

KW - Modified Mini-Mental State Exam (3MS)

KW - Renal function

UR - http://www.scopus.com/inward/record.url?scp=84959890797&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959890797&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2016.01.026

DO - 10.1053/j.ajkd.2016.01.026

M3 - Article

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

ER -