Freedman Barry I, Sink Kaycee M, Hugenschmidt Christina E, Hughes Timothy M, Williamson Jeff D, Whitlow Christopher T, Palmer Nicholette D, Miller Michael E, Lovato Laura C, Xu Jianzhao, Smith S Carrie, Launer Lenore J, Barzilay Joshua I, Cohen Robert M, Sullivan Mark D, Bryan R Nick, Wagner Benjamin C, Bowden Donald W, Maldjian Joseph A, Divers Jasmin
Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Am J Kidney Dis. 2017 Nov;70(5):627-637. doi: 10.1053/j.ajkd.2017.05.006. Epub 2017 Jun 23.
Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM).
Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM.
SETTING & PARTICIPANTS: African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American-Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n=512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n=484; 104 with MRI) studies.
eGFR (CKD-EPI creatinine equation), spot UACR.
MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed.
Mean participant age was 60.1±7.9 (SD) years; diabetes duration, 12.1±7.7 years; hemoglobin A concentration, 8.3%±1.7%; eGFR, 88.7±21.6mL/min/1.73m; and UACR, 119.2±336.4mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P<0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P<0.05) and lower eGFR (P<0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P<0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests.
Cross-sectional; single UACR measurement.
In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.
在患有2型糖尿病（T2DM）的非裔美国人中，早期肾脏疾病、神经认知功能和脑解剖结构之间的关系尚不明确。
在患有T2DM的非裔美国人中，评估了脑解剖结构与认知表现之间的横断面关联，以及估算肾小球滤过率（eGFR）和尿白蛋白肌酐比值（UACR）。
在非裔美国人糖尿病心脏研究糖尿病记忆研究（AA-DHS MIND；n = 512；480人进行了磁共振成像）和糖尿病心血管风险控制行动（ACCORD）MIND（n = 484；104人进行了磁共振成像）研究中，对非裔美国人进行了认知测试和脑磁共振成像（MRI）。
eGFR（CKD-EPI肌酐方程），即时UACR。
基于MRI的脑白质体积（WMV）、灰质体积（GMV）和白质病变体积；认知表现（简易精神状态检查表、数字符号编码、斯特鲁普测试和雷伊听觉词语学习测试）。在每项研究中，使用调整了年龄、性别、体重指数、扫描仪、颅内体积、教育程度、糖尿病病程、血红蛋白A浓度、低密度脂蛋白胆固醇浓度、吸烟、高血压和心血管疾病的多变量模型来测试肾脏表型与大脑之间的关联；进行了荟萃分析。
参与者的平均年龄为60.1±7.9（标准差）岁；糖尿病病程为12.1±7.7岁；血红蛋白A浓度为8.3%±1.7%；eGFR为88.7±21.6mL/min/1.73m²；UACR为119.2±336.4mg/g。在完全调整的荟萃分析中，较高的GMV与较低的UACR相关（P<0.05），与较高的eGFR有相关趋势。较高的白质病变体积与较高的UACR相关（P<0.05）和较低的eGFR相关（P<0.001）。WMV与任何一个肾脏参数均无关联。较高的UACR与较低的数字符号编码表现相关（P<0.001），与较高的斯特鲁普干扰有相关趋势；eGFR与认知测试无关联。
横断面研究；单次UACR测量。
在患有T2DM的非裔美国人中，轻度升高的UACR和轻度降低的eGFR与较小的GMV和增加的白质病变体积相关。UACR与较差的处理速度和工作记忆相关。
