认知障碍与慢性肾脏病的进展
Cognitive Impairment and Progression of CKD.
作者信息
Kurella Tamura Manjula, Yaffe Kristine, Hsu Chi-Yuan, Yang Jingrong, Sozio Stephen, Fischer Michael, Chen Jing, Ojo Akinlolu, DeLuca Jennifer, Xie Dawei, Vittinghoff Eric, Go Alan S
机构信息
VA Palo Alto Geriatric Research and Education Clinical Center; Division of Nephrology, Stanford University School of Medicine; Palo Alto, CA.
Department of Psychiatry, University of California San Francisco, San Francisco, CA; Department of Neurology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
出版信息
Am J Kidney Dis. 2016 Jul;68(1):77-83. doi: 10.1053/j.ajkd.2016.01.026. Epub 2016 Mar 10.
BACKGROUND
Cognitive impairment is common among patients with chronic kidney disease (CKD); however, its prognostic significance is unclear. We assessed the independent association between cognitive impairment and CKD progression in adults with mild to moderate CKD.
STUDY DESIGN
Prospective cohort.
SETTING & PARTICIPANTS: Adults with CKD participating in the CRIC (Chronic Renal Insufficiency Cohort) Study. Mean age of the sample was 57.7±11.0 years and mean estimated glomerular filtration rate (eGFR) was 45.0±16.9mL/min/1.73m(2).
PREDICTOR
Cognitive function was assessed with the Modified Mini-Mental State Examination at study entry. A subset of participants 55 years and older underwent 5 additional cognitive tests assessing different domains. Cognitive impairment was defined as a score > 1 SD below the mean score on each test. Covariates included demographics, kidney function, comorbid conditions, and medications.
OUTCOMES
Incident end-stage renal disease (ESRD) and incident ESRD or 50% decline in baseline eGFR.
RESULTS
In 3,883 CRIC participants, 524 (13.5%) had cognitive impairment at baseline. During a median 6.1 years of follow-up, 813 developed ESRD and 1,062 developed ESRD or a ≥50% reduction in eGFR. There was no significant association between cognitive impairment and risk for ESRD (HR, 1.07; 95% CI, 0.87-1.30) or the composite of ESRD or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.89-1.27). Similarly, there was no association between cognitive impairment and the joint outcome of death, ESRD, or 50% reduction in eGFR (HR, 1.06; 95% CI, 0.91-1.23). Among CRIC participants who underwent additional cognitive testing, we found no consistent association between impairment in specific cognitive domains and risk for CKD progression in adjusted analyses.
LIMITATIONS
Unmeasured potential confounders, single measure of cognition for younger participants.
CONCLUSIONS
Among adults with CKD, cognitive impairment is not associated with excess risk for CKD progression after accounting for traditional risk factors.
背景
认知障碍在慢性肾脏病（CKD）患者中很常见；然而，其预后意义尚不清楚。我们评估了轻度至中度CKD成人患者认知障碍与CKD进展之间的独立关联。
研究设计
前瞻性队列研究。
研究地点与参与者
参与CRIC（慢性肾功能不全队列）研究的CKD成人患者。样本的平均年龄为57.7±11.0岁，平均估计肾小球滤过率（eGFR）为45.0±16.9mL/min/1.73m²。
预测因素
在研究开始时用改良简易精神状态检查表评估认知功能。55岁及以上的部分参与者还接受了另外5项评估不同领域的认知测试。认知障碍定义为每项测试得分低于平均分1个标准差以上。协变量包括人口统计学特征、肾功能、合并症和用药情况。
研究结果
终末期肾病（ESRD）的发生情况以及ESRD的发生或基线eGFR下降50%。
结果
在3883名CRIC参与者中，524人（13.5%）在基线时存在认知障碍。在中位6.1年的随访期间，813人发展为ESRD，1062人发展为ESRD或eGFR降低≥50%。认知障碍与ESRD风险（风险比[HR]，1.07；95%置信区间[CI]，0.87 - 1.30）或ESRD或eGFR降低50%的综合情况（HR，1.06；95%CI，0.89 - 1.27）之间无显著关联。同样，认知障碍与死亡、ESRD或eGFR降低50%的联合结局之间也无关联（HR，1.06；95%CI，0.91 - 1.23）。在接受额外认知测试的CRIC参与者中，我们在调整分析中未发现特定认知领域损害与CKD进展风险之间存在一致关联。
局限性
未测量的潜在混杂因素，对年轻参与者仅进行了单次认知测量。
结论
在CKD成人患者中，在考虑传统风险因素后，认知障碍与CKD进展的额外风险无关。
Zotero 插件