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Kidney Week

Abstract: PO2283

Insulin Use and CKD Are Risk Factors for Mild Cognitive Impairment (MCI) or Dementia in Persons with Type 2 Diabetes

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Abraham, Nikita, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Carle, Judy, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Gonce, Victoria, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Hartsell, Sydney Elizabeth, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Both insulin use and CKD are risk factors for hypoglycemic episodes in patients with diabetes. Recurrent hypoglycemia is associated with increased risk of dementia. Hence, we examined whether insulin use and CKD are associated with increased risk of MCI/dementia.

Methods

We analyzed a national VA cohort (N =855,133) with T2DM defined by ICD-9 codes and
outpatient serum creat from 1/2008 to 12/2010. Index date was the date of first
outpatient serum creatinne measurement. Baseline comorbidities
were defined by ICD-9 codes from 10/1999 to the index date. MCI/ dementia were defined by ICD9/10 codes. Those with baseline MCI/dementia were excluded and new onset of MCI/dementia was tracked from index date to 12/31/2020.

A multivariate logistic regression model of baseline variables was used to develop propensity scores of
baseline insulin use (24% were on insulin at baseline). A propensity score matched cohort (N = 288,374) was
used to relate baseline insulin use and CKD stages with subsequent MCI/dementia in Cox regression
models.

Results

Baseline mean age was 65 ±11 yrs, 20% black and mean eGFR 72±24. There were 40,299 MCI/dementia events
over 2,439,244 years of follow up. There was a graded increase in incidence rate of MCI/dementia by CKD stages and insulin use (Fig1). In a Cox regression model adjusted for propensity scores and covariates, both insulin use and advanced CKD were associated with higher risk of MCI/dementia (Fig2).

Conclusion

Both insulin use and advanced CKD are associated with higher risk of MCI/dementia in persons with T2DM.

Funding

  • NIDDK Support