Abstract: TH-PO654
Association of CKD Markers with Dementia Markers on Brain MRI: The ARIC Study
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
- Scheppach, Johannes B., Johns Hopkins University, Baltimore, Maryland, United States
- Wu, Aozhou, The Johns Hopkins University, Baltimore, Maryland, United States
- Gottesman, Rebecca F., Johns Hopkins University, Baltimore, Maryland, United States
- Mosley, Tom, Univ. of Miss. Med Center, Jackson, Mississippi, United States
- Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States
- Sharrett, Richey, Johns Hopkins, Baltimore, Maryland, United States
- Coresh, Josef, Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland, United States
- Koton, Silvia, Tel Aviv University and Johns Hopkins University, Tel Aviv, Israel
Background
Urine albumin-creatinine-ratio (UACR) and estimated glomerular filtration rate (eGFR) define chronic kidney disease (CKD) and are associated with an increased risk of dementia and cognitive impairment. Such pathologies are accompanied with damage to the structural integrity of the brain, which can be seen using magnetic resonance imaging (MRI). We therefore examined the association of ACR and eGFR with MRI structural brain abnormalities in participants in the Atherosclerosis Risk in Communities (ARIC) study.
Methods
We studied 1,525 ARIC participants aged 67-90 years who attended visit 5 (2011-2013), and had a brain MRI scan performed, and eGFR based on cystatin C and UACR measured. We analyzed the association of UACR and eGFR with reduced brain volume, increased white matter hyperintensity (WMH) volume, micro-hemorrhages and brain infarcts using linear and logistic regression models, adjusted for age, sex, race, education, Apolipoprotein E4 level, smoking, body mass index, total cholesterol level, hypertension, diabetes, stroke and intracranial volume (only for volume measurements). Effect sizes for eGFR and ACR were normalized to their interquartile range (IQR).
Results
Higher levels of UACR and lower levels of eGFR were associated with reduced brain volume in regions typically affected by Alzheimer’s Dementia (AD), such as the hippocampus, and in non-AD related regions. Higher UACR and lower eGFR were also associated with increased WMH volume, and higher number of micro-hemorrhages and infarcts. The magnitude of the observed associations with MRI brain pathologies was similar between UACR and eGFR.
Conclusion
Higher UACR and lower eGFR are strongly associated with brain structural MRI abnormalities. These abnormalities include white matter lesions, infarcts, microhemorrhages and signs of brain atrophy, which manifest globally in regions typical for AD as well as other brain regions.
Pathology in brain MRI | Cystatin-based eGFR per 1-IQR decrease | Log UACR per 1-IQR increase | ||
Standardized beta coefficient (95%CI)1 | p-value | Standardized beta coefficient (95%CI)1 | p-value | |
Brain volume, AD signature region | -0.10 (-0.14 to -0.05) | <0.001 | -0.07 (-0.11 to -0.04) | <0.001 |
Brain volume, non-AD signature region | -0.05 (-0.08 to -0.02) | 0.003 | -0.05 (-0.07 to -0.02) | 0.001 |
Log WMH volume | 0.11 (0.04 to 0.17) | 0.001 | 0.10 (0.05 to 0.16) | <0.001 |
Odds ratio (95%CI)2 | Odds ratio (95%CI)2 | |||
Brain micro-hemorrhages | 1.14 (0.96 to 1.36) | 0.14 | 1.22 (1.07 to 1.40) | 0.003 |
Brain infarcts | 1.21 (1.02 to 1.45) | 0.033 | 1.33 (1.16 to 1.52) | <0.001 |
Table: Adjusted estimates for associations of eGFR and ACR with MRI brain pathological changes AD: Alzheimer's disease WMH: White matter hyperintensity 1Estimates from linear regression models including age, sex, race, education, Apolipoprotein E4 level, smoking, body mass index, total cholesterol level, hypertension, diabetes, stroke and intracranial volume as covariates 2Estimates from logistic regression models including age, sex, race, education, Apolipoprotein E4 level, smoking, body mass index, total cholesterol level, hypertension, diabetes and stroke as covariates |
Funding
- Other NIH Support