Zijlstra Laurien E, Trompet Stella, Mooijaart Simon P, van Buren Marjolijn, Sattar Naveed, Stott David J, Jukema J Wouter
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
BMC Nephrol. 2020 Mar 5;21(1):81. doi: 10.1186/s12882-020-01745-5.
Chronic kidney disease (CKD) has been identified as a significant direct marker for cognitive decline, but controversy exists regarding the magnitude of the association of kidney function with cognitive decline across the different CKD stages. Therefore, the aim of this study was to investigate the association of kidney function with cognitive decline in older patients at high risk of cardiovascular disease, using data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).
Data of 5796 patients of PROSPER were used. Strata were made according to clinical stages of CKD based on estimated glomerular filtration rate; < 30 ml/min/1.73m (stage 4), 30-45 ml/min/1.73m (stage 3b), 45-60 ml/min/1.73m (stage 3a) and ≥ 60 ml/min/1.73m (stage 1-2). Cognitive function and functional status was assessed at six different time points and means were compared at baseline and over time, adjusted for multiple prespecified variables. Stratified analyses for history of vascular disease were executed.
Mean age was 75.3 years and 48.3% participants were male. Mean follow-up was 3.2 years. For all cognitive function tests CKD stage 4 compared to the other stages had the worst outcome at baseline and a trend for faster cognitive decline over time. When comparing stage 4 versus stage 1-2 over time the estimates (95% CI) were 2.23 (0.60-3.85; p = 0.009) for the Stroop-Colour-Word test, - 0.33 (- 0.66-0.001; p = 0.051) for the Letter-Digit-Coding test, 0.08 (- 0.06-0.21; p = 0.275) for the Picture-Word-Learning test with immediate recall and - 0.07 (- 0.02-0.05; p = 0.509) for delayed recall. This association was most present in patients with a history of vascular disease. No differences were found in functional status.
In older people with vascular burden, only severe kidney disease (CKD stage 4), but not mild to modest kidney disease (CKD stage 3a and b), seem to be associated with cognitive impairment at baseline and cognitive decline over time. The association of severe kidney failure with cognitive impairment and decline over time was more outspoken in patients with a history of vascular disease, possibly due to a higher probability of polyvascular damage, in both kidney and brain, in patients with proven cardiovascular disease.
慢性肾脏病（CKD）已被确认为认知功能下降的一个重要直接指标，但对于不同CKD阶段的肾功能与认知功能下降之间关联的程度仍存在争议。因此，本研究旨在利用老年高危心血管疾病患者普伐他汀前瞻性研究（PROSPER）的数据，探讨肾功能与认知功能下降之间的关联。
使用了PROSPER研究中5796例患者的数据。根据基于估计肾小球滤过率的CKD临床阶段进行分层：<30ml/min/1.73m²（4期）、30 - 45ml/min/1.73m²（3b期）、45 - 60ml/min/1.73m²（3a期）和≥60ml/min/1.73m²（1 - 2期）。在六个不同时间点评估认知功能和功能状态，并在基线和随访期间比较均值，对多个预先设定的变量进行调整。对血管疾病史进行分层分析。
平均年龄为75.3岁，48.3%的参与者为男性。平均随访时间为3.2年。对于所有认知功能测试，与其他阶段相比，CKD 4期在基线时结果最差，且随着时间推移有认知功能下降更快的趋势。随着时间推移，比较4期与1 - 2期时，Stroop颜色-文字测试的估计值（95%CI）为2.23（范围0.60 - 3.85；p = 0.009），字母-数字编码测试为 - 0.33（范围 - 0.66 - 0.001；p = 0.051），即刻回忆的图片-文字学习测试为0.08（范围 - 0.06 - 0.21；p = 0.275），延迟回忆为 - 0.07（范围 - 0.02 - 0.05；p = 0.509）。这种关联在有血管疾病史的患者中最为明显。在功能状态方面未发现差异。
在有血管负担的老年人中，似乎只有严重肾病（CKD 4期），而非轻度至中度肾病（CKD 3a期和3b期），与基线时的认知障碍和随时间的认知功能下降有关。严重肾衰竭与认知障碍及随时间下降之间的关联在有血管疾病史的患者中更为明显，这可能是由于已证实有心血管疾病的患者在肾脏和大脑中发生多血管损伤的可能性更高。
