title: Biomarkers of renal function and cognitive impairment in patients with diabetes.
abstract: OBJECTIVE
  Kidney disease is associated with cognitive impairment in studies of nondiabetic adults. We examined the cross-sectional relation between three measures of renal function and performance on four measures of cognitive function in the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) study.
  
  
  METHODS
  The relationships among estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) (n = 2,968), albumin/creatinine ratio (ACR) ≥30 μg/mg (n = 2,957), and cystatin C level >1.0 mg/L (n = 532) with tertile of performance on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop Test of executive function were measured.
  
  
  RESULTS
  In adjusted logistic regression models, ACR ≥30 μg/mg was associated with performance in the lowest tertile, compared with the highest two tertiles, on the RAVLT (odds ratio 1.30, 95% CI 1.09-1.56, P = 0.006), equivalent to 3.6 years of aging, and on the DSST (1.47, 1.20-1.80, P = 0.001), equivalent to 3.7 years of aging. Cystatin C >1.0 mg/L was borderline associated with the lowest tertile on the DSST (1.81, 0.93-3.55, P = 0.08) and Stroop (1.78, 0.97-3.23, P = 0.06) in adjusted models. eGFR was not associated with any measure of cognitive performance.
  
  
  CONCLUSIONS
  In diabetic people with HbA(1c) >7.5% at high risk for cardiovascular disease, decreased cognitive function was associated with kidney disease as measured by ACR, a measure of microvascular endothelial pathology, and cystatin C, a marker of eGFR.
authors.affiliation: Department of Medicine, MinneapolisMedical Research Foundation, Minneapolis, MN, USA. amurray@cdrg.org
authors.forename: Anne M
authors.initials: AM
authors.lastname: Murray
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: James F
authors.initials: JF
authors.lastname: Lovato
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Michael E
authors.initials: ME
authors.lastname: Miller
authors.forename: Santica
authors.initials: S
authors.lastname: Marcovina
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
mesh_terms: D000418:Albumins / Q000378:metabolism; D003072:Cognition Disorders / Q000378:metabolism*; D003404:Creatinine / Q000378:metabolism; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000378:metabolism; D003920:Diabetes Mellitus / Q000378:metabolism* / Q000503:physiopathology*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D007668:Kidney / Q000378:metabolism* / Q000503:physiopathology*; D016015:Logistic Models
chemical_list: D000418:Albumins; D003404:Creatinine; D055316:Cystatin C; D006442:Glycated Hemoglobin