慢性肾脏病标志物与认知功能的相关性：一项为期 12 年的随访研究。
Associations of Chronic Kidney Disease Markers with Cognitive Function: A 12-Year Follow-Up Study.
机构信息
Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
Department of Medicine and Aged Care, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.
出版信息
J Alzheimers Dis. 2019;70(s1):S19-S30. doi: 10.3233/JAD-180498.
BACKGROUND
The role of chronic kidney disease (CKD) as a risk factor for cognitive impairment independent of their shared antecedents remains controversial.
OBJECTIVE
To determine whether kidney damage (indicated by albuminuria) or kidney dysfunction (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2) predict future (12-year) cognitive function independently of their shared risk factors.
METHODS
We studied 4,128 individuals from the 1999/00 population-based Australian Diabetes, Obesity, and Lifestyle (AusDiab) Study who returned in 2011/12 for follow-up cognitive function testing. Albuminuria was defined by urinary albumin:creatinine≥3.5 (women) or≥2.5 mg/mmol (men). Kidney dysfunction was indicated by eGFR <60 ml/min/1.73 m2. Cognitive function domains assessed included memory (California Verbal Learning Test [CVLT]) and processing speed (Symbol Digit Modalities Test [SDMT]).
RESULTS
Baseline albuminuria and kidney dysfunction were identified in 142 (3.4%) and 39 (0.9%) individuals, respectively, with minimal overlap (n = 7). Those with albuminuria demonstrated concurrently reduced 12-year SDMT (p = 0.084) and CVLT scores (p = 0.005) following adjustment for age, sex, and education. However, only CVLT performance remained worse (p = 0.027) following additional adjustment for myocardial infarction, stroke, and related risk factors (hypertension, diabetes, dyslipidemia, smoking, BMI, physical activity, and alcohol intake). Indeed, these collective covariates were responsible for 47% of the effect of albuminuria on SDMT, but only 21% of its effect on CVLT. Kidney dysfunction was not associated with either SDMT or CVLT performance (p > 0.10).
CONCLUSIONS
Albuminuria predicted worse memory function at 12 years follow-up, whereas its effect on processing speed was driven largely by differences in cardiovascular risk. Kidney dysfunction based on eGFR predicted neither cognitive domain.
背景
慢性肾脏病（CKD）作为认知障碍的独立危险因素，而不是其共同的前驱因素，其作用仍存在争议。
目的
确定肾脏损伤（由蛋白尿表示）或肾功能障碍（估计肾小球滤过率[eGFR]＜60ml/min/1.73m2）是否可以独立于其共同的危险因素预测未来（12 年）的认知功能。
方法
我们研究了 1999/00 年基于人群的澳大利亚糖尿病、肥胖和生活方式（AusDiab）研究中的 4128 名参与者，他们于 2011/12 年返回进行随访认知功能测试。蛋白尿定义为尿白蛋白：肌酐≥3.5（女性）或≥2.5mg/mmol（男性）。肾功能障碍由 eGFR＜60ml/min/1.73m2 表示。评估的认知功能域包括记忆（加利福尼亚语言学习测试[CVLT]）和处理速度（符号数字模态测试[SDMT]）。
结果
基线白蛋白尿和肾功能障碍分别在 142（3.4%）和 39（0.9%）名个体中被识别，两者之间几乎没有重叠（n=7）。蛋白尿患者在调整年龄、性别和教育程度后，12 年时的 SDMT（p=0.084）和 CVLT 评分（p=0.005）均同时降低。但是，仅在进一步调整心肌梗死、中风和相关危险因素（高血压、糖尿病、血脂异常、吸烟、BMI、身体活动和饮酒）后，CVLT 表现仍较差（p=0.027）。实际上，这些综合协变量解释了白蛋白尿对 SDMT 影响的 47%，但仅解释了对 CVLT 影响的 21%。肾功能障碍与 SDMT 或 CVLT 表现均无相关性（p＞0.10）。
结论
蛋白尿预测 12 年后记忆功能下降，而其对处理速度的影响在很大程度上归因于心血管风险的差异。基于 eGFR 的肾功能障碍既不能预测认知域。
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