Passos Valéria Maria de Azeredo, Ladeira Roberto Marini, Souza Cláudia Caciquinho Vieira de, Santos Itamar de Souza, Barreto Sandhi Maria
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, MG, Brasil.
J Bras Nefrol. 2018 Jan-Mar;40(1):18-25. doi: 10.1590/1678-4685-JBN-3889. Epub 2018 Apr 26.
The aging of the population may lead to an increased prevalence of dementia and chronic kidney disease (CKD) and their overlap.
We investigated the association between CKD and cognitive performance among Brazilian adults (35-74 years).
Baseline data analysis of the Longitudinal Study of Adults (ELSA-Brasil), a multicenter cohort comprising 15,105 civil servants, was performed. Kidney function was defined by the CKD-Epi-estimated GRF and albumin creatinin ratio (ACR). Cognitive performance was measured across tests that included the word memory tests, verbal fluency tests and Trail Making Test B. Multiple logistic and linear regressions were used to investigate the association between CKD and global as well as test-specific lowered cognitive performance.
More than 90% of participants did not present CKD even considering reduced GFR or increased ACR simultaneously. Lowered cognitive performance was detected among 15.8% of the participants and mean values of GFR were slightly higher among those with normal than with lowered cognitive performance (86 ± 15 mL/min/1.73 m2 x 85 ± 16 mL/min/1.73 m2, p < 0.01). Age, education, skin-color, smoking, drinking, hypertension, and diabetes were associated with lowered cognition. After adjustment for these variables, there was no association between CKD and lowered cognitive performance. Negligibly small beta values were observed when analyzing CKD and the scores of all tests.
These results suggest that cognitive performance remains preserved until renal function reaches significant worsening. Preventive measures to maintain renal function may contribute to the preservation of cognitive function.
人口老龄化可能导致痴呆症和慢性肾脏病（CKD）的患病率上升及其重叠情况。
我们调查了巴西成年人（35 - 74岁）中CKD与认知表现之间的关联。
对成人纵向研究（ELSA - Brasil）的基线数据分析进行了研究，该研究是一个包含15105名公务员的多中心队列。肾功能通过CKD - Epi估算的肾小球滤过率（GRF）和白蛋白肌酐比值（ACR）来定义。认知表现通过包括单词记忆测试、语言流畅性测试和连线测验B在内的测试进行测量。采用多元逻辑回归和线性回归来研究CKD与整体以及特定测试的认知表现降低之间的关联。
即使同时考虑肾小球滤过率降低或ACR升高，超过90%的参与者未出现CKD。15.8%的参与者检测到认知表现降低，认知表现正常者的GFR平均值略高于认知表现降低者（86±15 mL/min/1.73 m² 对 85±16 mL/min/1.73 m²，p < 0.01）。年龄、教育程度、肤色、吸烟、饮酒、高血压和糖尿病与认知降低有关。在对这些变量进行调整后，CKD与认知表现降低之间无关联。分析CKD与所有测试分数时观察到的β值极小。
这些结果表明，在肾功能显著恶化之前，认知表现保持完好。维持肾功能的预防措施可能有助于保护认知功能。
