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. 2011 Nov;58(5):756-63.
doi: 10.1053/j.ajkd.2011.05.027. Epub 2011 Aug 4.

Albuminuria, kidney function, and the incidence of cognitive impairment among adults in the United States

Affiliations

Albuminuria, kidney function, and the incidence of cognitive impairment among adults in the United States

Manjula Kurella Tamura et al. Am J Kidney Dis. 2011 Nov.

Abstract

Background: Albuminuria and estimated glomerular filtration rate (eGFR) are each associated with increased risk of cognitive impairment, but their joint association is unknown.

Study design: Prospective cohort study.

Setting & participants: A US national sample of 19,399 adults without cognitive impairment at baseline participating in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) Study.

Predictors: Albuminuria was assessed using urine albumin-creatinine ratio (UACR) and GFR was estimated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation.

Outcomes: Incident cognitive impairment was defined as score ≤4 on the 6-Item Screener at the last follow-up visit.

Results: During a mean follow-up of 3.8 ± 1.5 years, UACRs of 30-299 and ≥300 mg/g were associated independently with 31% and 57% higher risk of cognitive impairment, respectively, relative to individuals with UACR <10 mg/g. This finding was strongest for those with high eGFRs and attenuated at lower levels (P = 0.04 for trend). Relative to eGFR ≥60 mL/min/1.73 m(2), eGFR <60 mL/min/1.73 m(2) was not associated independently with cognitive impairment. However, after stratifying by UACR, eGFR <60 mL/min/1.73 m(2) was associated with a 30% higher risk of cognitive impairment in participants with UACR <10 mg/g, but not higher UACRs (P = 0.04 for trend).

Limitations: Single measures of albuminuria and eGFR, screening test of cognition.

Conclusions: When eGFR was preserved, albuminuria was associated independently with incident cognitive impairment. When albuminuria was <10 mg/g, low eGFR was associated independently with cognitive impairment. Albuminuria and low eGFR are complementary, but not additive, risk factors for incident cognitive impairment.

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Figures

Figure 1
Figure 1
Prevalence of albuminuria according to eGFR categories among included participants at baseline. There were N=9102 (47%), 8419 (43%), 1317 (7%) and 561 (3%) participants with eGFR ≥90, 60–89, 45–59, and <45 ml/min/1.73m2, respectively. Note: albuminuria is expressed as urine albumin-creatinine ratio (ACR, in mg/g). eGFR - estimated glomerular filtration rate.
Figure 2
Figure 2
Adjusted odds ratios for cognitive impairment over 3.8 years, by estimated glomerular filtration rate (eGFR, in ml/min/1.73m2) and urine albumin-creatinine ratio (ACR, in mg/g). The referent category is eGFR ≥90 ml/min/1.73m2 and ACR <30 mg/g. Odds ratios are adjusted for age, sex, race, education, region, diabetes, hypertension, cardiovascular disease, stroke, smoking and alcohol use. Bars represent 95% confidence intervals. N=297, 976, 7385, and 8141, respectively for categories ACR <30 mg/g and eGFR <45, 45–59, 60–89, and ≥90 ml/min/1.73m2. N=264, 342, 1033, and 961, respectively, for categories ACR ≥30 mg/g and eGFR <45, 45–59, 60–89, and ≥90 ml/min/1.73m2.

References

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