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Abstract: PO1746

Deoxycholic Acid (DCA) and Cognitive Impairment and Decline in the Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Nowak, Kristen L., University of Colorado Health, Aurora, Colorado, United States
  • Miyazaki, Makoto, University of Colorado Health, Aurora, Colorado, United States
  • Chonchol, Michel, University of Colorado Health, Aurora, Colorado, United States
  • Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Fischer, Michael J., University of Illinois at Chicago, Chicago, Illinois, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • He, Jiang, Tulane University, New Orleans, Louisiana, United States
  • Mills, Katherine T., Tulane University, New Orleans, Louisiana, United States
  • Wolfrum, Katherine Leilani, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
  • Kurella Tamura, Manjula, Standford University, Palo Alto, California, United States
  • Feldman, Harold I., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Isakova, Tamara, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Jovanovich, Anna, VA Eastern Colorado Health Care System, Aurora, Colorado, United States
Background

Cognitive impairment is common in chronic kidney disease (CKD). The secondary bile acid, DCA, is associated with endothelial dysfunction and oxidative stress, characteristics of cognitive impairment. DCA is also associated with cognitive impairment and risk of Alzheimer’s dementia among older adults without CKD. Whether DCA is associated with cognitive impairment in CKD is unknown.

Methods

We used multivariable-adjusted regression models to cross-sectionally and longitudinally evaluate the association between fasting serum DCA levels measured at visit 5 (considered baseline) and cognitive impairment. Among 2836 CRIC Study participants, cognitive impairment was assessed by the Mini-mental State Exam (MMSE). Among 698 participants enrolled in the CRIC Cognitive (COG) Study, cognitive impairment was further assessed by Trails A&B, Category Fluency, Buschke Recall, and Boston Naming tests. Cognitive impairment was defined by a test score >1 standard deviation (SD) worse than the test mean.

Results

Mean age was 59 ± 10 years, 45% were female, and 39% were black. In cross-sectional analyses, there was no association between DCA and cognitive impairment assessed by MMSE in the total cohort after adjustment for demographics and clinical factors (prevalence ratio per 1-SD increase ln DCA: 1.03, 95% CI 0.91-1.17). In longitudinal analyses, DCA was associated with progressive impairment (mean annual % change MMSE per 1-SD increase ln DCA: -0.15, 95% CI -0.34 - -0.02), but not with incident impairment. Among CRIC COG Study participants, in cross-sectional analyses DCA was associated with cognitive impairment based on Category Fluency (prevalence ratio per 1-SD increase ln DCA: 1.36, 95% CI 1.05-1.76) but not with other measures of impairment. In longitudinal analyses among CRIC COG Study participants, DCA was not associated with progressive or incident cognitive impairment.

Conclusion

Among individuals with CKD stages 2-4, higher DCA levels were independently associated with prevalent cognitive impairment in Category Fluency and progressive cognitive impairment assessed by MMSE.

Funding

  • NIDDK Support