title: Effect of chronic dementia caregiving and major transitions in the caregiving situation on kidney function: a longitudinal study.
abstract: OBJECTIVE
  To estimate the glomerular filtration rate (GFR) in relation to the chronic stress of dementia caregiving and major transitions in the caregiving situation.
  
  
  METHODS
  We longitudinally assessed 119 people serving as caregivers for their spouses with Alzheimer's disease and 58 noncaregiving controls for a period of up to 3 years (mean of 2.8 assessments per participant). At baseline, the mean (standard deviation [SD]) age of all participants was 74.5 (7.5) years. Random regression models with fixed and time-variant effects for psychosocial factors, risk factors of chronic kidney disease, and caregiving transitions were used to evaluate changes over time in estimated GFR.
  
  
  RESULTS
  The change in GFR did not differ between caregivers and controls during follow-up (p = .77). Further analyses revealed that GFR declined disproportionately after placement of the spouse in a nursing home at 3 months after placement (-4.9 [2.2] mL/min per 1.73 m(2); p = .03). Post hoc analyses showed that this effect was stronger in caregivers with hypertension compared with those without hypertension (-5.7 [3.1] versus -2.4 [3.4] mL/min per 1.73 m(2)), as well as in caregivers with diastolic blood pressure (BP) levels at 1 SD above the mean than in those with diastolic BP levels at 1 SD below the mean (-8.3 [2.9] versus -1.4 [2.7] mL/min per 1.73 m(2)).
  
  
  CONCLUSIONS
  Kidney function did not differ between caregivers and controls over time. However, GFR had impaired at 3 months after a major caregiving transition. Because the effect of placement of the spouse with Alzheimer's disease on the decline in GFR was moderated by BP, it might be confined to caregivers who experience increased sympathetic activation after placement.
authors.affiliation: Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland. roland.vonkaenel@insel.ch
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ziegler
authors.forename: Susan K
authors.initials: SK
authors.lastname: Roepke
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chattillion
authors.forename: Matthew
authors.initials: M
authors.lastname: Allison
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D001794:Blood Pressure / Q000502:physiology; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003704:Dementia / Q000451:nursing / Q000523:psychology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology* / Q000503:physiopathology; D008016:Life Change Events; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D012044:Regression Analysis; D012307:Risk Factors; D018454:Spouses / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors