title: Biomarkers of Renal Function in Type 2 Diabetic Patients with Cognitive Impairment.
abstract: 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 cognitive impairment (CI) in type 2 diabetic patients. A total of 357 patients with type 2 diabetes were prospectively enrolled. There were 108 patients with CI and 249 patients without CI (control). We calculated the urinary albumin/creatinine ratio (UACR) from morning spot urine and the estimated glomerular filtration rate (eGFR) in serum samples. Serum Cystatin C (Cys C) was measured with an automated particle-enhanced turbidimetric immunoassay. UACR and Cystatin C levels were significantly higher in patients with CI than those without CI (P<0.001), and the eGFR was lower in patients with CI than those without (P=0.003). A logistic regression analysis indicates that kidney impairment biomarkers levels were significantly associated with an increased risk of CI after adjustment for age and gender. The OR of each kidney biomarker (eGFR, UACR, Cystatin C) for CI status was 1.78 (0.89-3.27), 2.36 (1.29-4.42), and 2.77 (1.36-5.97), respectively. Among three kidney biomarkers (eGFR, UACR, Cystatin C), only elevated serum Cystatin C was associated with increased risk of CI in type 2 diabetic patients, with an OR of 1.42 (1.25-4.24) after additional adjustment for duration of diabetes, hypertension, hyperlipidemia, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (Hs-CRP), intima-media thickness (IMT), ankle brachial index (ABI), and brachial-ankle pulse wave velocity (ba-PWV). Furthermore, combination of conventional risk factors and Cystatin C levels exhibited a fair diagnostic value for CI, with an area under the curve (AUC) of 0.91. Among three kidney impairment biomarkers (eGFR, UACR, Cystatin C), only elevated serum Cystatin C was associated with increased risk of CI in type 2 diabetic patients, independent of conventional risk factors. Furthermore, Cystatin C may be a better marker for CI than eGFR and UACR, and exhibited diagnostic value.
authors.affiliation: Department of Neurology, Weihai Municipal Hospital, The Affiliated Hospital of Binzhou Medical College, Weihai, PR China.
authors.forename: Jin-Biao
authors.initials: JB
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Weihai Municipal Hospital, The Affiliated Hospital of Binzhou Medical College, Weihai, PR China.
authors.forename: Na
authors.initials: N
authors.lastname: Geng
authors.affiliation: Department of Neurology, Weihai Municipal Hospital, The Affiliated Hospital of Binzhou Medical College, Weihai, PR China.
authors.forename: Zhen-Guang
authors.initials: ZG
authors.lastname: Li
authors.affiliation: Department of Neurology, Weihai Municipal Hospital, The Affiliated Hospital of Binzhou Medical College, Weihai, PR China.
authors.forename: Hui-Jie
authors.initials: HJ
authors.lastname: Qiao
authors.affiliation: Department of Neurology, Weihai Municipal Hospital, The Affiliated Hospital of Binzhou Medical College, Weihai, PR China.
authors.forename: Hai-Rong
authors.initials: HR
authors.lastname: Sun
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Liaoning Medical University, No. 2, People Street Five, Guta District, Jin Zhou, Liaoning 12001, PR China. Electronic address: drlifang123@163.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Li
mesh_terms: D000368:Aged; D000418:Albumins / Q000032:analysis; D000419:Albuminuria / Q000097:blood / Q000175:diagnosis / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged
chemical_list: D000418:Albumins; D015415:Biomarkers; D055316:Cystatin C
keywords: Chronic kidney disease; Cognitive impairment; Cystatin C; Type 2 diabetes