Estimated GFR, Albuminuria, and Cognitive Performance: The Maastricht Study.
BACKGROUND
Reduced estimated glomerular filtration rate (eGFR) and albuminuria have been associated with worse cognitive performance. However, few studies have examined whether these associations are confined to older individuals or may be extended to the middle-aged population.


METHODS
Cross-sectional analyses of a prospective population-based cohort study.


METHODS
2,987 individuals aged 40 to 75 years from the general population (The Maastricht Study).


METHODS
eGFR and urinary albumin excretion (UAE).


RESULTS
Memory function, information processing speed, and executive function.


METHODS
Analyses were adjusted for demographic variables (age, sex, and educational level), lifestyle factors (smoking behavior and alcohol consumption), depression, and cardiovascular disease risk factors (glucose metabolism status, waist circumference, total to high-density lipoprotein cholesterol ratio, triglyceride level, use of lipid-modifying medication, systolic blood pressure, use of antihypertensive medication, and prevalent cardiovascular disease).


RESULTS
UAE was <15mg/24 h in 2,439 (81.7%) participants, 15 to <30 mg/24 h in 309 (10.3%), and ≥30mg/24 h in 239 (8.0%). In the entire study population, UAE≥30mg/24 h was associated with lower information processing speed as compared to UAE<15mg/24 h (β [SD difference] = -0.148; 95% CI, -0.263 to -0.033) after full adjustment, whereas continuous albuminuria was not. However, significant interaction terms (P for interaction < 0.05) suggested that albuminuria was most strongly and extensively associated with cognitive performance in older individuals. Mean (±SD) eGFR, estimated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-cystatin C equation (eGFRcr-cys), was 88.4±14.6 mL/min/1.73m2. eGFRcr-cyswas not associated with any of the domains of cognitive performance after full adjustment. However, significant interaction terms (P for interaction < 0.05) suggested that eGFRcr-cyswas associated with cognitive performance in older individuals.


CONCLUSIONS
Cross-sectional design, which limited causal inferences.


CONCLUSIONS
In the entire study population, albuminuria was independently associated with lower information processing speed, whereas eGFRcr-cyswas not associated with cognitive performance. However, both were more strongly and extensively associated with cognitive performance in older individuals.
Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
Remy J H
RJ
Martens
Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
Jeroen P
JP
Kooman
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Coen D A
CD
Stehouwer
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
Pieter C
PC
Dagnelie
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Carla J H
CJ
van der Kallen
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands.
Annemarie
A
Koster
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Abraham A
AA
Kroon
Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
Karel M L
KM
Leunissen
Department of General Practice, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Giel
G
Nijpels
Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
Frank M
FM
van der Sande
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
Nicolaas C
NC
Schaper
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Simone J S
SJ
Sep
Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
Martin P J
MP
van Boxtel
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Miranda T
MT
Schram
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands. Electronic address: rma.henry@mumc.nl.
Ronald M A
RM
Henry
D000328:Adult; D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D003071:Cognition; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged
Estimated glomerular filtration rate (eGFR); albuminuria; cognition; cognitive function; cognitive performance; executive function; information processing speed; kidney disease; kidney function; memory function; middle age; neuropsychological test battery; urinary albumin excretion (UAE)