Kidney Week

Abstract: FR-PO0285

Frontal Cerebral Blood Flow Decline Is Selectively Associated with Worsening Executive Function in CKD: Post Hoc Analyses of the SPRINT-MIND Study

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Gosalia, Jigar, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Jigar Gosalia, PhD

• You, Zhiying, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Zhiying You, MD, PhD

• Kurella Tamura, Manjula, Stanford University School of Medicine, Stanford, California, United States

Manjula Kurella Tamura, MD, MPH

• Chonchol, Michel, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Michel Chonchol, MD, FASN

• Brunt, Vienna E., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Vienna E. Brunt, PhD

• Nowak, Kristen L., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Kristen L. Nowak, PhD, MPH

Background

Chronic kidney disease (CKD) is associated with a two-fold increased risk of cognitive impairment, particularly executive dysfunction, a key characteristic of vascular dementia, suggesting a vascular etiology. Reduced cerebral blood flow (CBF) may contribute to cognitive decline in CKD. However, longitudinal data linking regional CBF changes to cognitive trajectories are limited and specifically for the frontal lobe, where executive functions are regulated. We investigated whether changes in global and frontal CBF were associated with changes in executive function, processing speed, and language in older adults with and without CKD.

Methods

We performed a post-hoc analysis of 318 adults 50+ yrs at high cardiovascular risk from the SPRINT MIND MRI sub-study (85 with CKD; 233 without CKD) with baseline and 4-year follow-up cognitive testing and arterial spin labeling MRI. CKD was defined as eGFR 20–59 mL/min/1.73m². Composite scores for executive function, processing speed, and language were calculated from standardized neuropsychological tests. Changes in global and frontal CBF were related to changes in cognitive scores using multivariable linear regression models adjusting for demographic and clinical lab values. Interaction terms were evaluated, and CKD-stratified analyses were performed.

Results

Changes in frontal CBF over the 4-year follow-up period were comparable between the CKD and non-CKD groups (CKD: -0.83 ± 8.34 mL/100g/min, non-CKD: 0.98 ± 10.79 mL/100g/min; p = 0.16). However, there was a significant interaction between CKD and frontal CBF (p = 0.047) such that decreases in frontal CBF were associated with declines in executive function in adults with CKD but not in those without CKD. Among CKD participants, a 10 mL/100g/min decrease in frontal CBF was associated with a 0.16-point (95% CI: 0.01, 0.32; fully adjusted model) decline in executive composite score in CKD participants. No associations were observed for processing speed or language.

Conclusion

Longitudinal reductions in frontal CBF are independently associated with declines in executive function in adults at high cardiovascular risk with CKD, suggesting that cerebrovascular dysfunction (frontal perfusion) may contribute to CKD-associated cognitive decline. Further mechanistic studies are needed to determine causality and intervention strategies.

Acknowledgment

Supported by: T32 DK007135, 1TL1DK147566-01 and R01DK130266

Funding

• NIDDK Support