title: Anemia and risk for cognitive decline in chronic kidney disease.
abstract: BACKGROUND
  Anemia is common among patients with chronic kidney disease (CKD) but its health consequences are poorly defined. The aim of this study was to determine the relationship between anemia and cognitive decline in older adults with CKD.
  
  
  METHODS
  We studied a subgroup of 762 adults age ≥55 years with CKD participating in the Chronic Renal Insufficiency Cohort (CRIC) study. Anemia was defined according to the World Health Organization criteria (hemoglobin <13 g/dL for men and <12 g/dL for women). Cognitive function was assessed annually with a battery of six tests. We used logistic regression to determine the association between anemia and baseline cognitive impairment on each test, defined as a cognitive score more than one standard deviation from the mean, and mixed effects models to determine the relation between anemia and change in cognitive function during follow-up after adjustment for demographic and clinical characteristics.
  
  
  RESULTS
  Of 762 participants with mean estimated glomerular filtration rate of 42.7 ± 16.4 ml/min/1.73 m(2), 349 (46 %) had anemia. Anemia was not independently associated with baseline cognitive impairment on any test after adjustment for demographic and clinical characteristics. Over a median 2.9 (IQR 2.6-3.0) years of follow-up, there was no independent association between anemia and change in cognitive function on any of the six cognitive tests.
  
  
  CONCLUSIONS
  Among older adults with CKD, anemia was not independently associated with baseline cognitive function or decline.
authors.affiliation: VA Palo Alto Geriatric Research and Education Clinical Center, 3801 Miranda Ave., Palo Alto, CA, 94304, USA. mktamura@stanford.edu.|Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA. mktamura@stanford.edu.
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Eric.vittinghoff@ucsf.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. Jingrong.yang@kp.org.
authors.forename: Jingrong
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. Alan.s.go@kp.org.|for the CRIC Study Investigators, Philadelphia, PA, USA. Alan.s.go@kp.org.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. sseliger@medicine.umaryland.edu.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA. kusekj@extra.niddk.nih.gov.|for the CRIC Study Investigators, Philadelphia, PA, USA. kusekj@extra.niddk.nih.gov.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: Department of Medicine, University of Illinois Chicago, Chicago, IL, USA. jplash@uic.edu.|for the CRIC Study Investigators, Philadelphia, PA, USA. jplash@uic.edu.
authors.forename: James
authors.initials: J
authors.lastname: Lash
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Debbie.cohen@uphs.upenn.edu.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Cohen
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. Simonj2@ccf.org.
authors.forename: James
authors.initials: J
authors.lastname: Simon
authors.affiliation: Department of Medicine, Tulane University Medical School, New Orleans, LA, USA. vbatuma@tulane.edu.
authors.forename: Vecihi
authors.initials: V
authors.lastname: Batuman
authors.affiliation: Division of Nephrology, Kaiser Permanente Northern California, Oakland, CA, USA. juan.ordonez@kp.org.
authors.forename: Juan
authors.initials: J
authors.lastname: Ordonez
authors.affiliation: St. John Providence Medical Center, Detroit, MI, USA. gmakos@scsp.net.
authors.forename: Gail
authors.initials: G
authors.lastname: Makos
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. kristine.yaffe@ucsf.edu.|Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA. kristine.yaffe@ucsf.edu.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology* / Q000523:psychology; D001288:Attention; D003072:Cognition Disorders / Q000097:blood / Q000209:etiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007802:Language; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008875:Middle Aged; D009949:Orientation; D011446:Prospective Studies; D011597:Psychomotor Performance; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D014145:Trail Making Test
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