Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Academic Article

Abstract

  • BACKGROUND: The association between kidney function and cognitive impairment has not been assessed in a national sample with a wide spectrum of kidney disease severity. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 23,405 participants (mean age, 64.9 +/- 9.6 years) with baseline measurements of creatinine and cognitive function participating in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a study of stroke risk factors in a large national sample. PREDICTOR: Estimated glomerular filtration rate (eGFR). OUTCOME: Cognitive impairment. MEASUREMENTS: Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min/1.73 m(2). Kidney function was analyzed in 10-mL/min/1.73 m(2) increments in those with CKD, and in exploratory analyses, across the range of kidney function. Cognitive function was assessed using the 6-Item Screener, and participants with a score of 4 or less were considered to have cognitive impairment. RESULTS: CKD was associated with an increased prevalence of cognitive impairment independent of confounding factors (odds ratio, 1.23; 95% confidence interval, 1.06 to 1.43). In patients with CKD, each 10-mL/min/1.73 m(2) decrease in eGFR less than 60 mL/min/1.73 m(2) was associated with an 11% increased prevalence of impairment (odds ratio, 1.11; 95% confidence interval, 1.04 to 1.19). Exploratory analyses showed a nonlinear association between eGFR and prevalence of cognitive impairment, with a significant increased prevalence of impairment in those with eGFR less than 50 and 100 mL/min/1.73 m(2) or greater. LIMITATIONS: Longitudinal measures of cognitive function were not available. CONCLUSIONS: In US adults, lower levels of kidney function are associated with an increased prevalence of cognitive impairment. The prevalence of impairment appears to increase early in the course of kidney disease; therefore, screening for impairment should be considered in all adults with CKD.
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    Keywords

  • Adult, Cognition, Cognition Disorders, Continental Population Groups, Glomerular Filtration Rate, Humans, Incidence, Kidney Failure, Chronic, Stroke, Topography, Medical, United States
  • Digital Object Identifier (doi)

    Author List

  • Kurella Tamura M; Wadley V; Yaffe K; McClure LA; Howard G; Go R; Allman RM; Warnock DG; McClellan W
  • Start Page

  • 227
  • End Page

  • 234
  • Volume

  • 52
  • Issue

  • 2