Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 70, Issue 3, Pages 357-367Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2017.04.021
Keywords
Kidney disease; cognition; dementia; albuminuria; brain; cardiovascular disease (CVD); cerebrovascular disease; brain imaging; white matter volume; neurocognitive test battery; urinary albumin-creatinine ratio (UACR); estimated glomerular filtration rate (eGFR); kidney function; global cognitive function; executive function; memory
Categories
Funding
- National Institutes of Health (NIH)
- National Heart, Lung, and Blood Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- National Institute on Aging
- National Institute of Neurological Disorders and Stroke [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN26820090 0048C, HHSN268200900049C]
- US Department of Veterans Affairs
- National Center for Advancing Translational Sciences: Case Western Reserve University [UL1TR000439]
- Ohio State University [UL1RR025755]
- University of Pennsylvania [UL1RR024134, UL1TR000003]
- Boston University [UL1RR025771]
- Stanford University [UL1TR000093]
- Tufts University [UL1RR025752, UL1TR000073, UL1TR001064]
- University of Illinois [UL1TR000050]
- University of Pittsburgh [UL1TR000005]
- University of Texas Southwestern [9U54TR000017-06]
- University of Utah [UL1TR000105-05]
- Vanderbilt University [UL1 TR000445]
- George Washington University [UL1TR000075]
- University of California, Davis [UL1 TR000002]
- University of Florida [UL1 TR000064]
- University of Michigan [UL1TR000433]
- Tulane University [P30GM103337]
- Centers of Biomedical Research Excellence Award, National Institute of General Medical Sciences
- NIDDK [R01 DK092241]
- [A-HL-13-002-001]
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Background: Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Study Design: Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Predictors: Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Outcomes: Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Results: Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8 +/- 20.9 mL/min/1.73 m(2) and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Limitations: Cross-sectional only, no patients with diabetes were included. Conclusions: In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting that vascular disease may mediate these relationships. (C) 2017 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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