Cognitive Impairment and Progression of CKD

Am J Kidney Dis. 2016 Jul;68(1):77-83. doi: 10.1053/j.ajkd.2016.01.026. Epub 2016 Mar 10.


Background: Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD.

Study design: Prospective cohort.

Setting & participants: Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2).

Predictor: Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications.

Outcomes: Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR.

Results: In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses.

Limitations: Unmeasured potential confounders, single measure of cognition for younger participants.

Conclusions: Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors.

Keywords: CRIC (Chronic Renal Insufficiency Cohort); Cognitive impairment; Modified Mini-Mental State Exam (3MS); attention; chronic kidney disease (CKD); cognitive function testing; concentration; disease progression; end-stage renal disease (ESRD); impaired cognitive function; memory; microvascular disease; renal function.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cognitive Dysfunction / complications*
  • Disease Progression
  • Female
  • Humans
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / etiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications*
  • Young Adult