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Kidney Week

Abstract: TH-PO652

Rapid eGFR Decline Is Not Associated with Cognitive Impairment

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Tollitt, James, Salford Royal NHS Trust, Salford, United Kingdom
  • Odudu, Aghogho, University of Manchester, Manchester, United Kingdom
  • Montaldi, Daniela, University of Manchester, Manchester, United Kingdom
  • Kalra, Philip A., Salford Royal Hospital NHS Trust, Salford, United Kingdom
Background

Cognitive impairment (CI) is underdiagnosed in patients with CKD. Unidentified CI may explain non-adherence to renal diet, fluid, medication and dialysis regimens. Determining if speed of eGFR decline is a significant risk factor for CI may help identify patients suffering from CI in CKD.

Methods

Patients enrolled into a UK longitudinal epidemiological non dialysis CKD cohort study without previously diagnosed CI underwent cognitive assessments.These included; Montreal Cognitive Assessment (MoCA) and Trail Making A and B (TMTA and TMTB). eGFR decline was measured by linear regression and percentage fall in eGFR prior to cognitive assessment. Multivariate logistic regression was performed for comorbidity and lifestyle values to determine factors predictive of CI. CI was defined as < 26 on MoCA and relative CI (rCI) defined by >-1.34SD of any cognitive Z score.

Results

250 participants completed the MoCA and 239 participants underwent the MoCA and TMT. 44% and 17% of participants were diagnosed with CI or rCI using MoCA score (adjusted for education) and the Z score respectively. Fast eGFR decline (>-3mL/min/yr), measured over median 58 antecedent months was not associated with CI (Odds Ratio (OR) 0.589 95%CI 0.313-1.109) or rCI (OR 0.864 95%CI 0.369-2.021) in unadjusted analysis. >50% and >20% egfr drop over study period was not associated with CI or rCI. Older age and previous stroke were associated with CI after comorbidity adjustments. Only age was associated with rCI after same adjustments (Image 1).

Conclusion

Cognitive impairment is common in patients with CKD. Speed of eGFR decline is not a significant risk factor for CI in patients with CKD.

The table shows OR for CI and rCI in unadjusted and models 1-4. Model 1 adjusted for age, model 2 adjusted for age and eGFR, model 3 adjusted for all variables listed except fast progression. Model 4 is adjusted for all variables listed except eGFR.