title: Cognitive Impairment and Progression of CKD.
abstract: BACKGROUND
  Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2).
  
  
  METHODS
  Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications.
  
  
  RESULTS
  Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR.
  
  
  RESULTS
  In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses.
  
  
  CONCLUSIONS
  Unmeasured potential confounders, single measure of cognition for younger participants.
  
  
  CONCLUSIONS
  Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors.
authors.affiliation: VA Palo Alto Geriatric Research and Education Clinical Center; Division of Nephrology, Stanford University School of Medicine; Palo Alto, CA. Electronic address: mktamura@stanford.edu.
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, CA; Department of Neurology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California; Oakland, CA.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Division of Research, Kaiser Permanente Northern California; Oakland, CA.
authors.forename: Jingrong
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Johns Hopkins University School of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research; Baltimore, MD.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sozio
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC and Edward Hines, Jr VA, Chicago, IL; University of Illinois Hospital and Health Sciences System, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Tulane University School of Medicine; New Orleans, LA.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Medicine, University of Michigan; Ann Arbor, MI.
authors.forename: Akinlolu
authors.initials: A
authors.lastname: Ojo
authors.affiliation: Renaissance Renal Research Institute; Detroit, MI.
authors.forename: Jennifer
authors.initials: J
authors.lastname: DeLuca
authors.affiliation: Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: Division of Research, Kaiser Permanente Northern California; Oakland, CA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000328:Adult; D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D055815:Young Adult
keywords: CRIC (Chronic Renal Insufficiency Cohort); Cognitive impairment; Modified Mini-Mental State Exam (3MS); attention; chronic kidney disease (CKD); cognitive function testing; concentration; disease progression; end-stage renal disease (ESRD); impaired cognitive function; memory; microvascular disease; renal function