Hailpern Susan M, Melamed Michal L, Cohen Hillel W, Hostetter Thomas H
Department of Epidemiology, Albert Einstein College of Medicine, Belfer 1006A, Bronx, NY 10461, USA.
J Am Soc Nephrol. 2007 Jul;18(7):2205-13. doi: 10.1681/ASN.2006101165. Epub 2007 Jun 6.
Previous studies among elderly suggest an association between chronic kidney disease (CKD) and cognitive impairment. The purpose of this study was to determine whether moderate CKD is associated with cognitive performance among young, healthy, ethnically diverse adults. Three computerized cognitive function tests of visual-motor reaction time (Simple Reaction Time), visual attention (Symbol Digit Substitution), and learning/concentration (Serial Digit Learning) were administered to a random sample of participants, aged 20 to 59 yr, who completed initial interviews and medical examination in the Third National Health and Nutrition Examination Survey (NHANES III). Participants for this study (n = 4849) completed at least one cognitive function test. GFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. Moderate CKD was defined as estimated GFR (eGFR) 30 to 59 ml/min per 1.73 m(2). Unadjusted, residual-adjusted, and multivariate-adjusted logistic regression models were used. The cohort was 49.0% male and 11.6% black, and median (interquartile range) age was 36 yr (27 to 45) and eGFR was 107.9 ml/min per 1.73 m(2) (95.0 to 125.4). There were 31 (0.8%) prevalent cases of moderate CKD. Models were adjusted for residual effects of age, gender, race, diabetes, and other known potential confounders. In multivariate models, moderate CKD was not significantly associated with reaction time but was significantly associated with poorer learning/concentration (odds ratio 2.41; 95% confidence interval 1.30 to 5.63) and impairment in visual attention (odds ratio 2.74; 95% confidence interval 1.01 to 7.40). In summary, among those in a large nationally representative sample of healthy, ethnically diverse 20- to 59-yr-old adults, moderate CKD, reflected by eGFR 30 to 59 ml/min per 1.73 m(2), was significantly associated with poorer performance in visual attention and learning/concentration.
先前针对老年人的研究表明，慢性肾脏病（CKD）与认知障碍之间存在关联。本研究的目的是确定中度CKD是否与年轻、健康、种族多样的成年人的认知表现相关。对年龄在20至59岁之间、在第三次全国健康和营养检查调查（NHANES III）中完成了初步访谈和医学检查的参与者随机样本进行了三项计算机化认知功能测试，即视觉运动反应时间（简单反应时间）、视觉注意力（符号数字替换）和学习/注意力集中（连续数字学习）测试。本研究的参与者（n = 4849）完成了至少一项认知功能测试。使用肾脏病饮食改良（MDRD）方程估算肾小球滤过率（GFR）。中度CKD定义为估算的GFR（eGFR）为30至59 ml/（min·1.73 m²）。使用了未调整、残差调整和多变量调整的逻辑回归模型。该队列中男性占49.0%，黑人占11.6%，年龄中位数（四分位间距）为36岁（27至45岁），eGFR为107.9 ml/（min·1.73 m²）（95.0至125.4）。有31例（0.8%）中度CKD的现患病例。模型对年龄、性别、种族、糖尿病和其他已知潜在混杂因素的残差效应进行了调整。在多变量模型中，中度CKD与反应时间无显著关联，但与较差的学习/注意力集中显著相关（比值比2.41；95%置信区间1.30至5.63），与视觉注意力受损显著相关（比值比2.74；95%置信区间1.01至7.40）。总之，在一个具有全国代表性的大型样本中，年龄在20至59岁、健康且种族多样的成年人中，以eGFR 30至59 ml/（min·1.73 m²）为反映的中度CKD与视觉注意力和学习/注意力集中方面较差的表现显著相关。
