Biomarkers of renal function and cognitive impairment in patients with diabetes

Anne M. Murray, Joshua I. Barzilay, James F. Lovato, Jeff D. Williamson, Michael E. Miller, Santica Marcovina, Lenore J. Launer

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

OBJECTIVE - 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 performance on four measures of cognitive function in the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) study. RESEARCH DESIGN AND METHODS - The relationships among estimated glomerular filtration rate (eGFR),60 mL/min/1.73m 2 (n = 2,968), albumin/creatinine ratio (ACR)≥30 μg/mg (n = 2,957), and cystatin C level .1.0 mg/L (n = 532) with tertile of performance on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop Test of executive function were measured. RESULTS - In adjusted logistic regression models, ACR ≥30 μg/mg was associated with performance in the lowest tertile, compared with the highest two tertiles, on the RAVLT (odds ratio 1.30, 95%CI 1.09-1.56, P = 0.006), equivalent to 3.6 years of aging, and on the DSST (1.47, 1.20-1.80, P = 0.001), equivalent to 3.7 years of aging. Cystatin C > 1.0 mg/L was borderline associated with the lowest tertile on the DSST (1.81, 0.93-3.55, P = 0.08) and Stroop (1.78, 0.97-3.23, P = 0.06) in adjusted models. eGFR was not associated with any measure of cognitive performance. CONCLUSIONS - In diabetic people with HbA 1c >7.5% at high risk for cardiovascular disease, decreased cognitive function was associated with kidney disease as measured by ACR, a measure of microvascular endothelial pathology, and cystatin C, a marker of eGFR.

Original languageEnglish (US)
Pages (from-to)1827-1832
Number of pages6
JournalDiabetes care
Volume34
Issue number8
DOIs
StatePublished - Aug 2011

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