title: Chronic kidney disease, creatinine and cognitive functioning.
abstract: BACKGROUND
  Non-dialysis-dependent chronic kidney disease (CKD) is related to cognitive impairment. Previous studies have not explored the extent of impairment across multiple cognitive domains. We examined the range of specific cognitive abilities affected by CKD and whether the associations of CKD with cognition were eliminated by statistical control for cardiovascular disease correlates of CKD.
  
  
  METHODS
  We performed a community-based cross-sectional study with 923 individuals free from dementia and end-stage renal disease. Two groups were defined based on estimated glomerular filtration rate (eGFR): eGFR<60 mL/min/1.73 m(2) versus eGFR >or= 60 mL/min/1.73 m(2). Outcome measures were scores from multiple clinical tests of specific cognitive abilities. The GFR classifications and serum creatinine levels were related to measures of cognitive performance using logistic and linear regression analyses with three sets of covariates: (1) basic (age, education, gender and race); (2) basic+risk factors for cardiovascular disease (CVD) and (3) basic+risk factors for CVD+stroke.
  
  
  RESULTS
  An eGFR <60 mL/min/1.73 m(2) was present in 142 (15.4%) individuals; the mean (SD) eGFR in this subgroup was 49.7 (10.7). CKD was related to lower cognitive performance despite adjustment for CVD risk factors (CVD-RF). Adjusting for CVD-RF and stroke, odds ratios and 95% confidence intervals associated with performing in the lowest quartile of the distribution of the Global, Visual-Spatial Organization/Memory and Scanning and Tracking scores for the eGFR < 60 group were 1.97 (1.25, 3.10); 1.88 (1.21, 2.93) and 1.83 (1.56, 2.87), P < 0.01 with eGFR >or= 60 group as the reference group.
  
  
  CONCLUSIONS
  Global performance and specific cognitive functions are negatively affected early in CKD. Targeted screening for cognitive deficits in kidney disease patients early in their disease course may be warranted.
authors.affiliation: Department of Psychology, Graduate School of Biomedical Sciences, University of Maine, Orono, ME, USA. mfelias@aol.com
authors.forename: Merrill F
authors.initials: MF
authors.lastname: Elias
authors.forename: Penelope K
authors.initials: PK
authors.lastname: Elias
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.forename: Sriram S
authors.initials: SS
authors.lastname: Narsipur
authors.forename: Gregrory A
authors.initials: GA
authors.lastname: Dore
authors.forename: Michael A
authors.initials: MA
authors.lastname: Robbins
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D003404:Creatinine / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology
chemical_list: D003404:Creatinine