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Abstract: TH-PO774

Cognitive Impairment and Trajectories in CKD: The REGARDS Study

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Cheung, Katharine L., University of Vermont College of Medicine, Burlington, Vermont, United States
  • Arce Renteria, Miguel, Columbia University, New York, New York, United States
  • Callas, Peter W., University of Vermont College of Medicine, Burlington, Vermont, United States
  • Tamura, Manjula, Stanford University School of Medicine, Stanford, California, United States
  • Gutierrez, Orlando M., The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Cushman, Mary, University of Vermont College of Medicine, Burlington, Vermont, United States
Background

CKD is associated with incident cognitive impairment (ICI) but it is unknown if longitudinal cognitive function has a different trajectory in CKD, or if age or race differences exist.

Methods

We studied 22,435 participants from the REGARDS study without baseline cognitive impairment. Participants completed the six-item screener (SIS) of global cognition every 6 months and 3 cognitive domain tests every 2 years for 10 years. ICI was defined as a SIS score ≤4. Multivariable logistic regression was used to calculate odds ratios of ICI as a function of eGFR. Latent growth curve models were used to determine the relationship of eGFR<60 ml/min/1.73m2 to intercept and slope of each cognitive domain test (episodic memory, semantic and letter F fluencies) over time. Up to five cognitive examinations were analyzed.

Results

13% (n=2,959) developed ICI over 10 years. As compared to eGFR ≥90 ml/min/1.73m2 (reference), eGFR 60-<90, 45-<60, and <45 had unadjusted ORs (95%CI) of 1.8 (1.6, 1.9), 2.7 (2.3, 3.1) and 2.7 (2.2, 3.3). Accounting for other risk factors, there was a significant interaction of eGFR and age (p<0.001); compared to eGFR>90, the OR for ICI at eGFR <45 was 1.9 (1.2, 3.0) for age <65, whereas OR for eGFR<45 v eGFR>90 was 0.9 (0.7, 1.1) for age≥65 (Table 1). Compared to those with eGFR≥60, eGFR<60 was associated with lower baseline scores across all 3 cognitive domains, but the slope did not differ (Table 2). Baseline scores were lower in mid-life compared to late-life, whereas no differences by race were observed.

Conclusion

CKD is associated with increased risk of ICI and lower cognitive domain testing in mid-life compared to late-life. Strategies to reduce cognitive impairment should focus on mid-life.

Table 1

Table 2

Funding

  • Other NIH Support