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Kidney Week

Abstract: PO1386

Kidney-Metabolic Risk Factors for Cognitive Impairment in Moderate CKD in the BRINK Study: Beyond eGFR and Albuminuria

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Murray, Anne M., The Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Tupper, David, Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Davey, Cynthia S., University of Minnesota Clinical and Translational Science Institute, Minneapolis, Minnesota, United States
  • Mello, Ryan, Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Hart, Allyson, Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States
Background

Decreased kidney function is a risk factor for cognitive impairment (CI). We sought to identify kidney-metabolic biomarkers beyond eGFR and albuminuria associated with prevalent moderate to severe cognitive impairment (Mod/Sev CI) in a CKD cohort.

Methods

Community-dwelling non-dialysis participants aged ≥ 45 years with CKD (eGFR <60, in mL/min/1.73 m2) were recruited from four health systems. We examined biomarkers including phosphorus, TNFαR1, PTH, calcium, total cholesterol, hemoglobin A1c%, bicarbonate (CO2). A neuropsychological battery measured global and domain-specific cognitive performance. Logistic regression analyses estimated cross-sectional associations between kidney-metabolic measures and global and cognitive-domain-specific Mod/Sev CI at baseline, adjusted for eGFR, urinary albumin-creatinine ratio (UACR, in mg/g), demographics, and comorbid conditions.

Results

Among 436 CKD participants with mean age 70 years, 16% were Black, mean eGFR was 34 and median UACR. In adjusted models no kidney-metabolic biomarkers were significantly associated with global Mod/Sev CI. However, in cognitive-domain-specific analyses, low bicarbonate (CO2 <20 mEq/L) was significantly associated with Mod/Sev impairment in memory [OR (95%CI): 3.04 (1.09, 8.47) P=0.03)] and with language [3.82 (1.12, 13.0; P=0.03). In addition, lower total cholesterol was associated with impaired executive function [1.12 per -10mg/dL (1.02, 1.23; P=0.02].

Conclusion

Low bicarbonate (acidosis) and lower cholesterol levels in older patients with CKD may be modifiable kidney-metabolic risk factors for Mod/Sev domain-specific CI in CKD. Longitudinal analyses are needed to determine whether low bicarbonate and low cholesterol are associated with cognitive decline.