title: Kidney dysfunction and cognitive decline in women.
abstract: OBJECTIVE
  ESRD is associated with substantial cognitive deficits but whether earlier kidney dysfunction predicts cognitive decline is less well defined.
  
  
  METHODS
  More than 1700 women aged ≥70 years in the Nurses' Health Study had plasma creatinine and urinary albumin/creatinine ratios (ACRs) measured in 2000, within 12 months of their initial cognitive testing. These participants had repeated assessments of cognition administered by phone every 2 years, including tests for general cognition, verbal memory, verbal fluency, and working memory for up to 6 years of follow-up. Mixed-effects regression analysis was applied to calculate mean differences in the rate of cognitive decline between women with an estimated GFR <60 ml/min per 1.73 m(2) or an ACR ≥5 mg/g versus referent levels.
  
  
  RESULTS
  The median age was 74 years at initial cognitive testing, 99% of women were Caucasian, median plasma creatinine was 0.8 mg/dl, and 25% had an ACR ≥5 mg/g. The difference in cognitive decline with a baseline ACR ≥5 mg/g versus an ACR <5 mg/g was equivalent to the difference observed with 2-7 years of aging; that is, a higher ACR was associated with 2-7 times faster decline in all four cognitive domains assessed (all P values <0.05) than that attributed to each 1 year of aging alone. No associations were observed between an eGFR <60 ml/min per 1.73 m(2) and cognitive decline.
  
  
  CONCLUSIONS
  A baseline urinary ACR ≥5 mg/g, a level not traditionally considered clinically significant, is independently associated with faster decline in cognitive function.
authors.affiliation: Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Imran
authors.initials: I
authors.lastname: Sajjad
authors.forename: Francine
authors.initials: F
authors.lastname: Grodstein
authors.forename: Jae H
authors.initials: JH
authors.lastname: Kang
authors.forename: Gary C
authors.initials: GC
authors.lastname: Curhan
authors.forename: Julie
authors.initials: J
authors.lastname: Lin
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008568:Memory; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003404:Creatinine