TY - JOUR
T1 - Estimated GFR, Albuminuria, and Cognitive Performance
T2 - The Maastricht Study
AU - Martens, Remy J H
AU - Kooman, Jeroen P
AU - Stehouwer, Coen D A
AU - Dagnelie, Pieter C
AU - van der Kallen, Carla J H
AU - Koster, Annemarie
AU - Kroon, Abraham A
AU - Leunissen, Karel M L
AU - Nijpels, Giel
AU - van der Sande, Frank M
AU - Schaper, Nicolaas C
AU - Sep, Simone J S
AU - van Boxtel, Martin P J
AU - Schram, Miranda T
AU - Henry, Ronald M A
N1 - Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
PY - 2017/2
Y1 - 2017/2
N2 - 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.STUDY DESIGN: Cross-sectional analyses of a prospective population-based cohort study.SETTING & PARTICIPANTS: 2,987 individuals aged 40 to 75 years from the general population (The Maastricht Study).PREDICTOR: eGFR and urinary albumin excretion (UAE).OUTCOMES: Memory function, information processing speed, and executive function.MEASUREMENTS: 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/1.73m(2). eGFRcr-cys was 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-cys was associated with cognitive performance in older individuals.LIMITATIONS: Cross-sectional design, which limited causal inferences.CONCLUSIONS: In the entire study population, albuminuria was independently associated with lower information processing speed, whereas eGFRcr-cys was not associated with cognitive performance. However, both were more strongly and extensively associated with cognitive performance in older individuals.
AB - 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.STUDY DESIGN: Cross-sectional analyses of a prospective population-based cohort study.SETTING & PARTICIPANTS: 2,987 individuals aged 40 to 75 years from the general population (The Maastricht Study).PREDICTOR: eGFR and urinary albumin excretion (UAE).OUTCOMES: Memory function, information processing speed, and executive function.MEASUREMENTS: 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/1.73m(2). eGFRcr-cys was 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-cys was associated with cognitive performance in older individuals.LIMITATIONS: Cross-sectional design, which limited causal inferences.CONCLUSIONS: In the entire study population, albuminuria was independently associated with lower information processing speed, whereas eGFRcr-cys was not associated with cognitive performance. However, both were more strongly and extensively associated with cognitive performance in older individuals.
KW - Estimated glomerular filtration rate (eGFR)
KW - albuminuria
KW - cognitive performance
KW - kidney function
KW - kidney disease
KW - urinary albumin excretion (UAE)
KW - cognitive function
KW - cognition
KW - memory function
KW - information processing speed
KW - executive function
KW - neuropsychological test battery
KW - middle age
KW - CHRONIC KIDNEY-DISEASE
KW - GLOMERULAR-FILTRATION-RATE
KW - NORMATIVE DATA
KW - OLDER-ADULTS
KW - CYSTATIN C
KW - MULTIPLE IMPUTATION
KW - IMPAIRMENT
KW - DECLINE
KW - MICROALBUMINURIA
KW - DEMENTIA
U2 - 10.1053/j.ajkd.2016.04.017
DO - 10.1053/j.ajkd.2016.04.017
M3 - Article
C2 - 27291486
SN - 0272-6386
VL - 69
SP - 179
EP - 191
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -