TY - JOUR
T1 - Cognitive Impairment and Progression of CKD
AU - Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
AU - Tamura, Manjula Kurella
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 - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - He, Jiang
AU - Kusek, John W.
AU - Lash, James P.
AU - Rahman, Mahboob
AU - Townsend, Raymond R.
N1 - Funding Information:
Support: Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; U01DK060990 , U01DK060984 , U01DK061022 , U01DK061021 , U01DK061028 , U01DK060980 , U01DK060963 , and U01DK060902 ). In addition, this work was supported in part by the following: the University of Pennsylvania Clinical and Translational Research Center Clinical and Translational Science Award (CTSA) UL1 RR-024134 , Johns Hopkins University UL1 RR-025005 , University of Maryland General Clinical Research Center M01 RR-16500 , Clinical and Translational Science Collaborative of Cleveland, UL1 TR-000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research, Michigan Institute for Clinical and Health Research UL1 RR-024986 , University of Illinois at Chicago CTSA UL1 RR-029879 , Tulane University Translational Research in Hypertension and Renal Biology P30 GM-103337 , and Kaiser NIH/National Center for Research Resources University of California San Francisco-Clinical and Translational Science Institute UL1 RR-024131 . Funding for the CRIC Cognitive study is supported by R01 DK-069406 from the NIDDK .
PY - 2016/7/1
Y1 - 2016/7/1
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 ± 16.9 mL/min/1.73 m2. 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 ± 16.9 mL/min/1.73 m2. 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 - 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
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
C2 - 26972681
AN - SCOPUS:84959890797
SN - 0272-6386
VL - 68
SP - 77
EP - 83
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -