认知与肾功能：来自巴西人群的研究结果
Cognition and renal function: findings from a Brazilian population.
作者信息
Chaiben Viviane Bernardes de Oliveira, Silveira Thabata Baechtold da, Guedes Murilo Henrique, Fernandes João Pedro de Almeida, Ferreira João Henrique Fregadolli, Beltrão Julianna, Leal Giovanna Foltran, Erbano Lucas Henrique Olandoski, Bosch Natasha Ludmila, Pecoits Filho Roberto, Moraes Thyago Proença de, Baena Cristina Pellegrino
机构信息
Pontifícia Universidade Católica do Paraná, Departamento de Medicina, Curitiba, PR, Brasil.
Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, PR, Brasil.
出版信息
J Bras Nefrol. 2019 Apr-Jun;41(2):200-207. doi: 10.1590/2175-8239-jbn-2018-0067. Epub 2018 Sep 13.
INTRODUCTION
The prevalence of chronic kidney disease (CKD) is increasing, with a potential impact in the risk of acceleration of dementia. The potential association between glomerular filtration rate (eGFR) and cognitive performance was scarcely studied. The aim of this study was to evaluate cognitive performance levels across different degrees of kidney function.
METHODS
We analyzed 240 outpatients in a nephrology service, classified according to eGFR: Advanced (≤ 30ml/min/1.73m2), Moderate (30,1ml/min/1.73m2 to ≤ 60ml/min/1.73m2), and Mild CKD (> 60ml/min/1.73m2). Word list memory, Semantic fluency, Mental State Mini Exam and Trail Making Test (TMT) were applied to evaluate cognitive performance. In the TMT, lower scores are associated with better cognition. In linear regression, cognitive function was considered as dependent variables while groups based on eGFR were considered explanatory variables. The group with eGFR > 60ml/min was the reference and models were adjusted for confounding factors.
RESULTS
In our population (n = 240) 64 patients (26.7%) were classified as having advanced, 98(40,8%) moderate, and 78(32,5%) mild. There was no statistical difference among them in MMSE or in the verbal fluency test. However, comparing to mild, patients with advanced CKD presented significantly worse cognitive performance measured by TMTA [50,8s ± 31.1s versus 66,6s ± 35,7s (p = 0.016)] and TMTB [92,7s ± 46,2s versus 162,4s ± 35,7s (p < 0.001)]. Significantly lower TMTB scores (CI95%) 33,0s (4,5-61,6s) were observed in patients with mild compared to advanced CKD in the multivariate analysis adjusting for age, education, sex, diabetes, and alcohol use.
CONCLUSION
Advanced CKD is independently associated with poorer cognitive performance measured by an executive performance test compared to mild CKD.
引言
慢性肾脏病（CKD）的患病率正在上升，对痴呆症加速风险可能产生影响。肾小球滤过率（eGFR）与认知表现之间的潜在关联鲜有研究。本研究的目的是评估不同程度肾功能下的认知表现水平。
方法
我们分析了肾病科的240名门诊患者，根据eGFR进行分类：重度（≤30ml/min/1.73m²）、中度（30.1ml/min/1.73m²至≤60ml/min/1.73m²）和轻度CKD（>60ml/min/1.73m²）。应用单词列表记忆、语义流畅性、精神状态简易检查和连线测验（TMT）来评估认知表现。在TMT中，得分越低与认知越好相关。在线性回归中，认知功能被视为因变量，而基于eGFR的分组被视为解释变量。eGFR>60ml/min的组为参照组，并对模型进行混杂因素调整。
结果
在我们的研究人群（n = 240）中，64名患者（26.7%）被分类为重度，98名（40.8%）为中度，78名（32.5%）为轻度。他们在简易精神状态检查表（MMSE）或语言流畅性测试中没有统计学差异。然而，与轻度患者相比，重度CKD患者在TMTA [50.8秒±31.1秒对66.6秒±35.7秒（p = 0.016）]和TMTB [92.7秒±46.2秒对162.4秒±35.7秒（p < 0.001）]测量的认知表现明显更差。在多变量分析中，调整年龄、教育程度、性别、糖尿病和饮酒情况后，与重度CKD患者相比，轻度患者的TMTB得分（95%置信区间）显著更低，为33.0秒（4.5 - 61.6秒）。
结论
与轻度CKD相比，重度CKD与通过执行能力测试测量的较差认知表现独立相关。
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