Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study.
OBJECTIVE
To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors.


METHODS
Cross-sectional.


METHODS
Chronic Renal Insufficiency Cohort Study.


METHODS
Eight hundred twenty-five adults aged 55 and older with CKD.


METHODS
Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m(2)) was estimated using the four-variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score < or =1 standard deviations from the mean).


RESULTS
Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1-3.9), naming (AOR=1.9, 95% CI=1.0-3.3), attention (AOR=2.4, 95% CI=1.3-4.5), executive function (AOR=2.5, 95% CI=1.9-4.4), and delayed memory (AOR=1.5, 95% CI=0.9-2.6) but not on category fluency (AOR=1.1, 95% CI=0.6-2.0) than those with mild to moderate CKD (eGFR 45-59).


CONCLUSIONS
In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment.
Yaffe
Kristine
K
Department of Psychiatry, School of Medicine, University of California at San Francisco, San Francisco, California, USA. kristine.yaffe@ucsf.edu
Ackerson
Lynn
L
Kurella Tamura
Manjula
M
Le Blanc
Patti
P
Kusek
John W
JW
Sehgal
Ashwini R
AR
Cohen
Debbie
D
Anderson
Cheryl
C
Appel
Lawrence
L
Desalvo
Karen
K
Ojo
Akinlolu
A
Seliger
Stephen
S
Robinson
Nancy
N
Makos
Gail
G
Go
Alan S
AS
D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology