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Review
. 2008 Aug;52(2):227-34.
doi: 10.1053/j.ajkd.2008.05.004. Epub 2008 Jun 30.

Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Manjula Kurella Tamura  1 , Virginia Wadley, Kristine Yaffe, Leslie A McClure, George Howard, Rodney Go, Richard M Allman, David G Warnock, William McClellan
Affiliations
Review

Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Manjula Kurella Tamura et al. Am J Kidney Dis. 2008 Aug.

Abstract

Background: The association between kidney function and cognitive impairment has not been assessed in a national sample with a wide spectrum of kidney disease severity.

Study design: Cross-sectional.

Setting & participants: 23,405 participants (mean age, 64.9 +/- 9.6 years) with baseline measurements of creatinine and cognitive function participating in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a study of stroke risk factors in a large national sample.

Predictor: Estimated glomerular filtration rate (eGFR).

Outcome: Cognitive impairment.

Measurements: Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min/1.73 m(2). Kidney function was analyzed in 10-mL/min/1.73 m(2) increments in those with CKD, and in exploratory analyses, across the range of kidney function. Cognitive function was assessed using the 6-Item Screener, and participants with a score of 4 or less were considered to have cognitive impairment.

Results: CKD was associated with an increased prevalence of cognitive impairment independent of confounding factors (odds ratio, 1.23; 95% confidence interval, 1.06 to 1.43). In patients with CKD, each 10-mL/min/1.73 m(2) decrease in eGFR less than 60 mL/min/1.73 m(2) was associated with an 11% increased prevalence of impairment (odds ratio, 1.11; 95% confidence interval, 1.04 to 1.19). Exploratory analyses showed a nonlinear association between eGFR and prevalence of cognitive impairment, with a significant increased prevalence of impairment in those with eGFR less than 50 and 100 mL/min/1.73 m(2) or greater.

Limitations: Longitudinal measures of cognitive function were not available.

Conclusions: In US adults, lower levels of kidney function are associated with an increased prevalence of cognitive impairment. The prevalence of impairment appears to increase early in the course of kidney disease; therefore, screening for impairment should be considered in all adults with CKD.

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Figures

Figure 1
Figure 1
Derivation of the analytic cohort
Figure 2
Figure 2
A Distribution of estimated glomerular filtration rate (GFR). B. Distribution of scores on Six-item Screener
Figure 3
Figure 3
Unadjusted prevalence of cognitive impairment and of cerebrovascular disease by estimated glomerular filtration rate (GFR, in ml/min/1.73m2).
See this image and copyright information in PMC

Comment in

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