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

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

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Cognition / physiology
  • Cognition Disorders* / ethnology
  • Cognition Disorders* / etiology
  • Cognition Disorders* / physiopathology
  • Continental Population Groups*
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Incidence
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / physiopathology*
  • Stroke / complications*
  • Stroke / ethnology
  • Stroke / physiopathology
  • Topography, Medical*
  • United States / epidemiology