Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease

Christine M. Burns; David S. Knopman; David E. Tupper; Cynthia S. Davey; Yelena M. Slinin; Kamakshi Lakshminarayan; Rebecca C. Rossom; Sarah L. Pederson; David T. Gilbertson; Anne M. Murray

doi:10.1093/gerona/glx241

Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease

Christine M. Burns, David S. Knopman, David E. Tupper, Cynthia S. Davey, Yelena M. Slinin, Kamakshi Lakshminarayan, Rebecca C. Rossom, Sarah L. Pederson, David T. Gilbertson, Anne M. Murray

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

Abstract

Background Our primary goal is to describe the prevalence, severity, and risk of cognitive impairment (CI) by estimated glomerular filtration rate (eGFR, in mL/min/1.73 m 2) in a cohort enriched for advanced chronic kidney disease (CKD; eGFR < 45), adjusting for albuminuria, as measured by urine albumin-to-creatinine ratio (UACR, in mg/g). As both eGFR and albuminuria are associated with CI risk in CKD, we also seek to determine the extent that eGFR remains a useful biomarker for risk of CI in those with CKD and concomitant albuminuria. Methods Chi-square tests measured the prevalence of severe CI and mild cognitive impairment (MCI) by eGFR level. Logistic regression models and generalized linear models measured risk of CI by eGFR, adjusted for UACR. Results Participants were 574 adults with a mean age of 69; 433 with CKD (eGFR < 60, nondialysis) and 141 controls (eGFR ≥ 60). Forty-eight percent of participants with CKD had severe CI or MCI. The prevalence of severe CI was highest (25%) in those with eGFR < 30. eGFR < 30 was only associated with severe CI in those without albuminuria (UACR < 30; OR = 3.3; p =.02) and was not associated with MCI in similar models. Conclusions One quarter of those with eGFR < 30 had severe CI. eGFR < 30 was associated with over threefold increased odds of severe CI in those with UACR < 30, but not with UACR > 30, suggesting that eGFR < 30 is a valid biomarker for increased risk of severe CI in those without concomitant albuminuria.

Original language	English (US)
Pages (from-to)	393-399
Number of pages	7
Journal	Journals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume	73
Issue number	3
DOIs	https://doi.org/10.1093/gerona/glx241
State	Published - Mar 2 2018

Bibliographical note

Funding Information:
Address correspondence to: Christine M. Burns, PhD, Neuropsychology Research Fellow, Minneapolis Medical Research Foundation, Hennepin County Medical Center, 701 Park Ave S2.306, Minneapolis, MN 55415. E-mail: burns359@umn.edu

Funding Information:
1Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minnesota. 2Department of Neurology, University of Minnesota, Minneapolis. 3Department of Neurology, Mayo Clinic, Rochester, Minnesota. 4Department of Psychology and Neuropsychology, Hennepin County Medical Center, Minneapolis, Minnesota. 5Biostatistical Design and Analysis Center, University of Minnesota Clinical and Translational Science Institute, Minneapolis. 6Minneapolis VA Health Care Center, Minnesota. 7Department of Medicine, University of Minnesota, Minneapolis. 8Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis. 9HealthPartners Institute, Bloomington, Minnesota. 10Chronic Disease Research Group, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minnesota. 11Geriatrics Division, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

Funding Information:
This work was supported by National Institute on Aging Grant # R01 AG03755, Satellite Health Inc., the Minneapolis Medical Research Foundation and grant number UL1TR000114 from the National Center for Research Resources, National Institutes of Health.

Publisher Copyright:
© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

Keywords

Cognitive aging
Dementia
Epidemiology
Renal

Publisher link

10.1093/gerona/glx241

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861955

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Burns, C. M., Knopman, D. S., Tupper, D. E., Davey, C. S., Slinin, Y. M., Lakshminarayan, K., Rossom, R. C., Pederson, S. L., Gilbertson, D. T., & Murray, A. M. (2018). Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 73(3), 393-399. https://doi.org/10.1093/gerona/glx241

Burns, CM, Knopman, DS, Tupper, DE, Davey, CS, Slinin, YM, Lakshminarayan, K, Rossom, RC, Pederson, SL, Gilbertson, DT & Murray, AM 2018, 'Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 73, no. 3, pp. 393-399. https://doi.org/10.1093/gerona/glx241

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title = "Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease",

abstract = "Background Our primary goal is to describe the prevalence, severity, and risk of cognitive impairment (CI) by estimated glomerular filtration rate (eGFR, in mL/min/1.73 m 2) in a cohort enriched for advanced chronic kidney disease (CKD; eGFR < 45), adjusting for albuminuria, as measured by urine albumin-to-creatinine ratio (UACR, in mg/g). As both eGFR and albuminuria are associated with CI risk in CKD, we also seek to determine the extent that eGFR remains a useful biomarker for risk of CI in those with CKD and concomitant albuminuria. Methods Chi-square tests measured the prevalence of severe CI and mild cognitive impairment (MCI) by eGFR level. Logistic regression models and generalized linear models measured risk of CI by eGFR, adjusted for UACR. Results Participants were 574 adults with a mean age of 69; 433 with CKD (eGFR < 60, nondialysis) and 141 controls (eGFR ≥ 60). Forty-eight percent of participants with CKD had severe CI or MCI. The prevalence of severe CI was highest (25%) in those with eGFR < 30. eGFR < 30 was only associated with severe CI in those without albuminuria (UACR < 30; OR = 3.3; p =.02) and was not associated with MCI in similar models. Conclusions One quarter of those with eGFR < 30 had severe CI. eGFR < 30 was associated with over threefold increased odds of severe CI in those with UACR < 30, but not with UACR > 30, suggesting that eGFR < 30 is a valid biomarker for increased risk of severe CI in those without concomitant albuminuria.",

keywords = "Cognitive aging, Dementia, Epidemiology, Renal",

author = "Burns, {Christine M.} and Knopman, {David S.} and Tupper, {David E.} and Davey, {Cynthia S.} and Slinin, {Yelena M.} and Kamakshi Lakshminarayan and Rossom, {Rebecca C.} and Pederson, {Sarah L.} and Gilbertson, {David T.} and Murray, {Anne M.}",

note = "Funding Information: Address correspondence to: Christine M. Burns, PhD, Neuropsychology Research Fellow, Minneapolis Medical Research Foundation, Hennepin County Medical Center, 701 Park Ave S2.306, Minneapolis, MN 55415. E-mail: burns359@umn.edu Funding Information: 1Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minnesota. 2Department of Neurology, University of Minnesota, Minneapolis. 3Department of Neurology, Mayo Clinic, Rochester, Minnesota. 4Department of Psychology and Neuropsychology, Hennepin County Medical Center, Minneapolis, Minnesota. 5Biostatistical Design and Analysis Center, University of Minnesota Clinical and Translational Science Institute, Minneapolis. 6Minneapolis VA Health Care Center, Minnesota. 7Department of Medicine, University of Minnesota, Minneapolis. 8Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis. 9HealthPartners Institute, Bloomington, Minnesota. 10Chronic Disease Research Group, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minnesota. 11Geriatrics Division, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota. Funding Information: This work was supported by National Institute on Aging Grant # R01 AG03755, Satellite Health Inc., the Minneapolis Medical Research Foundation and grant number UL1TR000114 from the National Center for Research Resources, National Institutes of Health. Publisher Copyright: {\textcopyright} The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.",

year = "2018",

month = mar,

day = "2",

doi = "10.1093/gerona/glx241",

language = "English (US)",

volume = "73",

pages = "393--399",

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T1 - Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease

AU - Burns, Christine M.

AU - Knopman, David S.

AU - Tupper, David E.

AU - Davey, Cynthia S.

AU - Slinin, Yelena M.

AU - Lakshminarayan, Kamakshi

AU - Rossom, Rebecca C.

AU - Pederson, Sarah L.

AU - Gilbertson, David T.

AU - Murray, Anne M.

N1 - Funding Information: Address correspondence to: Christine M. Burns, PhD, Neuropsychology Research Fellow, Minneapolis Medical Research Foundation, Hennepin County Medical Center, 701 Park Ave S2.306, Minneapolis, MN 55415. E-mail: burns359@umn.edu Funding Information: 1Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minnesota. 2Department of Neurology, University of Minnesota, Minneapolis. 3Department of Neurology, Mayo Clinic, Rochester, Minnesota. 4Department of Psychology and Neuropsychology, Hennepin County Medical Center, Minneapolis, Minnesota. 5Biostatistical Design and Analysis Center, University of Minnesota Clinical and Translational Science Institute, Minneapolis. 6Minneapolis VA Health Care Center, Minnesota. 7Department of Medicine, University of Minnesota, Minneapolis. 8Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis. 9HealthPartners Institute, Bloomington, Minnesota. 10Chronic Disease Research Group, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minnesota. 11Geriatrics Division, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota. Funding Information: This work was supported by National Institute on Aging Grant # R01 AG03755, Satellite Health Inc., the Minneapolis Medical Research Foundation and grant number UL1TR000114 from the National Center for Research Resources, National Institutes of Health. Publisher Copyright: © The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

PY - 2018/3/2

Y1 - 2018/3/2

N2 - Background Our primary goal is to describe the prevalence, severity, and risk of cognitive impairment (CI) by estimated glomerular filtration rate (eGFR, in mL/min/1.73 m 2) in a cohort enriched for advanced chronic kidney disease (CKD; eGFR < 45), adjusting for albuminuria, as measured by urine albumin-to-creatinine ratio (UACR, in mg/g). As both eGFR and albuminuria are associated with CI risk in CKD, we also seek to determine the extent that eGFR remains a useful biomarker for risk of CI in those with CKD and concomitant albuminuria. Methods Chi-square tests measured the prevalence of severe CI and mild cognitive impairment (MCI) by eGFR level. Logistic regression models and generalized linear models measured risk of CI by eGFR, adjusted for UACR. Results Participants were 574 adults with a mean age of 69; 433 with CKD (eGFR < 60, nondialysis) and 141 controls (eGFR ≥ 60). Forty-eight percent of participants with CKD had severe CI or MCI. The prevalence of severe CI was highest (25%) in those with eGFR < 30. eGFR < 30 was only associated with severe CI in those without albuminuria (UACR < 30; OR = 3.3; p =.02) and was not associated with MCI in similar models. Conclusions One quarter of those with eGFR < 30 had severe CI. eGFR < 30 was associated with over threefold increased odds of severe CI in those with UACR < 30, but not with UACR > 30, suggesting that eGFR < 30 is a valid biomarker for increased risk of severe CI in those without concomitant albuminuria.

AB - Background Our primary goal is to describe the prevalence, severity, and risk of cognitive impairment (CI) by estimated glomerular filtration rate (eGFR, in mL/min/1.73 m 2) in a cohort enriched for advanced chronic kidney disease (CKD; eGFR < 45), adjusting for albuminuria, as measured by urine albumin-to-creatinine ratio (UACR, in mg/g). As both eGFR and albuminuria are associated with CI risk in CKD, we also seek to determine the extent that eGFR remains a useful biomarker for risk of CI in those with CKD and concomitant albuminuria. Methods Chi-square tests measured the prevalence of severe CI and mild cognitive impairment (MCI) by eGFR level. Logistic regression models and generalized linear models measured risk of CI by eGFR, adjusted for UACR. Results Participants were 574 adults with a mean age of 69; 433 with CKD (eGFR < 60, nondialysis) and 141 controls (eGFR ≥ 60). Forty-eight percent of participants with CKD had severe CI or MCI. The prevalence of severe CI was highest (25%) in those with eGFR < 30. eGFR < 30 was only associated with severe CI in those without albuminuria (UACR < 30; OR = 3.3; p =.02) and was not associated with MCI in similar models. Conclusions One quarter of those with eGFR < 30 had severe CI. eGFR < 30 was associated with over threefold increased odds of severe CI in those with UACR < 30, but not with UACR > 30, suggesting that eGFR < 30 is a valid biomarker for increased risk of severe CI in those without concomitant albuminuria.

KW - Cognitive aging

KW - Dementia

KW - Epidemiology

KW - Renal

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Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease

Abstract

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