Chronic kidney disease, physical activity and cognitive function in older adults-results from the National Health and Nutrition Examination Survey (2011-2014)

Abstract

Background: Cognitive impairment is common among persons with chronic kidney disease (CKD), due in part to reduced kidney function. Given that physical activity (PA) is known to mitigate cognitive decline, we examined whether associations between CKD stage and global/domain-specific cognitive function differ by PA.

Methods: We leveraged 3223 participants (≥60 years of age) enrolled in National Health and Nutrition Examination Survey (NHANES, 2011-2014), with at least one measure of objective cognitive function [immediate recall (CERAD-WL), delayed recall (CERAD-DR), verbal fluency (AF), executive function/processing speed (DSST), global (average of four tests) or self-perceived memory decline (SCD)]. We quantified the association between CKD stage {no CKD: estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2 and albuminuria [albumin:creatinine ratio (ACR)] <30 mg/g; stages G1-G3: eGFR ≥60 mL/min/1.73 m2 and ACR ≥30 mg/g or eGFR 30-59 mL/min/1.73 m2; stages G4 and G5: eGFR <30 mL/min/1.73 m2} and cognitive function using linear regression (objective measures) and logistic regression (SCD), accounting for sampling weights for nationally representative estimates. We tested whether associations differed by PA [Global Physical Activity Questionnaire, high PA ≥600 metabolic equivalent of task (MET) · min/week versus low PA <600 MET · min/week] using a Wald test.

Results: Among NHANES participants, 34.9% had CKD stages G1-G3, 2.6% had stages G4 and G5 and 50.7% had low PA. CKD stages G4 and G5 were associated with lower global cognitive function {difference = -0.38 standard deviation [SD] [95% confidence interval (CI) -0.62 to -0.15]}. This association differed by PA (Pinteraction = 0.01). Specifically, among participants with low PA, those with CKD stages G4 and G5 had lower global cognitive function [difference = -0.57 SD (95% CI -0.82 to -0.31)] compared with those without CKD. Among those with high PA, no difference was found [difference = 0.10 SD (95% CI -0.29-0.49)]. Similarly, the CKD stage was only associated with immediate recall, verbal fluency, executive function and processing speed among those with low PA; no associations were observed for delayed recall or self-perceived memory decline.

Conclusions: CKD is associated with lower objective cognitive function among those with low but not high PA. Clinicians should consider screening older patients with CKD who have low PA for cognitive impairment and encourage them to meet PA guidelines.

Keywords: CKD; GFR; elderly; epidemiology; physical activity.

Graphical Abstract

FIGURE 1:

Objective cognitive test scores by CKD stage and physical activity level among participants ≥60 years of age from the NHANES (2011–2014) (N = 3223). Medians and IQRs are presented for cognitive test scores (standardized to a mean of 0 and an SD of 1). NHANES sampling weights were accounted for to obtain nationally representative estimates. Serum creatinine was measured and used to calculate eGFR with the CKD-EPI equation. CKD stage was then defined by the following cut-points: no CKD: eGFR ≥60 mL/min/1.73 m² and ACR <30 mg/g; CKD stages G1–G3: eGFR 30–59 mL/min/1.73 m² or eGFR ≥60 mL/min/1.73 m² and ACR ≥30 mg/g; CKD stages G4 and G5: eGFR <30 mL/min/1.73 m². Physical activity was collected using the Global Physical Activity Questionnaire and converted to MET·min/week, where ≥600 MET·min/week represents high physical activity.