Decline in kidney function over the course of adulthood and cognitive function in midlife

Sanaz Sedaghat, Farzaneh Sorond, Kristine Yaffe, Stephen Sidney, Holly J. Kramer, David R. Jacobs, Lenore J. Launer, Mercedes R. Carnethon

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


OBJECTIVE: To test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife.

METHODS: We included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35 years, 54% women, 45% Black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at year (Y) 10 through Y30. At each visit, moderate/high risk of ESRD according to the Kidney Disease: Improving Global Outcomes guidelines (estimated glomerular filtration rate <60 mL/min/1.73 m 2 or albumin-to-creatinine ratio >30 mg/g) was defined, totaled over examinations, and categorized into 0 episodes, 1 episode, and >1 episodes of ESRD risk. At Y30, participants underwent global and multidomain cognitive assessment. We used analysis of covariance to assess the association of ESRD risk categories with cognitive function, controlling for cardiovascular risk factors.

RESULTS: Over the course of 20 years, 427 participants (16% of the study population) had ≥1 episodes of ESRD risk exposure. Individuals with more risk episodes had lower composite cognitive function ( p < 0.001), psychomotor speed ( p < 0.001), and executive function ( p = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors.

CONCLUSIONS: In this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to preserve cognitive function in midlife.

Original languageEnglish (US)
Pages (from-to)E2389-E2397
Issue number17
StatePublished - Oct 27 2020

Bibliographical note

Publisher Copyright:
© American Academy of Neurology.


  • Adult
  • Albumins/analysis
  • Cardiovascular Diseases/epidemiology
  • Cognition
  • Cognitive Dysfunction/psychology
  • Creatinine/blood
  • Executive Function
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kidney Failure, Chronic/psychology
  • Kidney Function Tests
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Prospective Studies
  • Reaction Time
  • Risk Factors
  • Young Adult

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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