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Observational Study
. 2014 Sep;62(9):1623-9.
doi: 10.1111/jgs.12986. Epub 2014 Aug 14.

Higher levels of cystatin C are associated with worse cognitive function in older adults with chronic kidney disease: the chronic renal insufficiency cohort cognitive study

Kristine Yaffe  1 , Manjula Kurella-Tamura, Lynn Ackerson, Tina D Hoang, Amanda H Anderson, Mark Duckworth, Alan S Go, Marie Krousel-Wood, John W Kusek, James P Lash, Akinlolu Ojo, Nancy Robinson, Ashwini R Sehgal, James H Sondheimer, Susan Steigerwalt, Raymond R Townsend; CRIC Study Investigators
Collaborators, Affiliations
Observational Study

Higher levels of cystatin C are associated with worse cognitive function in older adults with chronic kidney disease: the chronic renal insufficiency cohort cognitive study

Kristine Yaffe et al. J Am Geriatr Soc. 2014 Sep.

Abstract

Objectives: To determine the association between cognition and levels of cystatin C in persons with chronic kidney disease (CKD).

Design: Prospective observational study.

Setting: Chronic Renal Insufficiency Cohort Cognitive Study.

Participants: Individuals with a baseline cognitive assessment completed at the same visit as serum cystatin C measurement (N = 821; mean age 64.9, 50.6% male, 48.6% white).

Measurements: Levels of serum cystatin C were categorized into tertiles; cognitive function was assessed using six neuropsychological tests. Scores on these tests were compared across tertiles of cystatin C using linear regression and logistic regression to examine the association between cystatin C level and cognitive performance (1 standard deviation difference from the mean).

Results: After multivariable adjustment for age, race, education, and medical comorbidities in linear models, higher levels of cystatin C were associated with worse cognition on the modified Mini-Mental State Examination, Buschke Delayed Recall, Trail-Making Test Part (Trails) A and Part B, and Boston Naming (P < .05 for all). This association remained statistically significant for Buschke Delayed Recall (P = .01) and Trails A (P = .03) after additional adjustment for estimated glomerular filtration rate (eGFR). The highest tertile of cystatin C was associated with greater likelihood of poor performance on Trails A (odds ratio (OR) = 2.17, 95% confidence interval (CI) = 1.16-4.06), Trails B (OR = 1.89, 95% CI = 1.09-3.27), and Boston Naming (OR = 1.85, 95% CI = 1.07-3.19) than the lowest tertile after multivariate adjustment in logistic models.

Conclusion: In individuals with CKD, higher serum cystatin C levels were associated with worse cognition and greater likelihood of poor cognitive performance on attention, executive function, and naming. Cystatin C is a marker of cognitive impairment and may be associated with cognition independent of eGFR.

Keywords: chronic kidney disease; cognition; cystatin C.

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Conflict of interest statement

Conflict of Interest:

Dr. Yaffe is a consultant for Novartis and serves on data safety monitoring boards for Takeda, Inc and a study sponsored by the NIH and on the Beeson Scientific Advisory Board.

Figures

Figure
Figure. Adjusteda Odds Ratios and 95% Confidence Intervals for Poor Cognitive Performance across Cystatin C Tertile (low as the reference)
a Models are adjusted for age, race, education, diabetes, hypertension, coronary heart disease, and stroke
See this image and copyright information in PMC

References

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