From the Departments of Preventive Medicine (S. Sedaghat, M.R.C.) and Neurology (S. Sedaghat, F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California; San Francisco Veterans Affairs Medical Center (K.Y.); Division of Research (S. Sidney), Kaiser Permanente Northern California, Oakland; Department of Public Health Sciences, Medicine, and Division of Nephrology and Hypertension (H.J.K.), Loyola University Medical Center, Maywood, IL; Division of Epidemiology and Community Health (D.R.J.), School of Public Health, University of Minnesota, Minneapolis; and National Institute on Aging (L.J.L.), Baltimore, MD.
Neurology. 2020 Oct 27;95(17):e2389-e2397. doi: 10.1212/WNL.0000000000010631. Epub 2020 Sep 2.
To test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife.
We included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35 years, 54% women, 45% Black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at year (Y) 10 through Y30. At each visit, moderate/high risk of ESRD according to the Kidney Disease: Improving Global Outcomes guidelines (estimated glomerular filtration rate <60 mL/min/1.73 m or albumin-to-creatinine ratio >30 mg/g) was defined, totaled over examinations, and categorized into 0 episodes, 1 episode, and >1 episodes of ESRD risk. At Y30, participants underwent global and multidomain cognitive assessment. We used analysis of covariance to assess the association of ESRD risk categories with cognitive function, controlling for cardiovascular risk factors.
Over the course of 20 years, 427 participants (16% of the study population) had ≥1 episodes of ESRD risk exposure. Individuals with more risk episodes had lower composite cognitive function ( < 0.001), psychomotor speed ( < 0.001), and executive function ( = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors.
In this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to preserve cognitive function in midlife.
验证假设，即成年早期的终末期肾病（ESRD）风险暴露与中年认知表现较差有关。
我们纳入了来自基于人群的冠状动脉风险发展在年轻人（CARDIA）研究的 2604 名参与者（平均年龄 35 岁，54%为女性，45%为黑人）。在 Y10 至 Y30 期间，每年测量一次肾小球滤过率估计值和白蛋白-肌酐比。在每次就诊时，根据肾脏病：改善全球结果指南（肾小球滤过率<60 mL/min/1.73 m 或白蛋白-肌酐比>30 mg/g）定义中度/高 ESRD 风险，检查总次数，分为 0 次、1 次和>1 次 ESRD 风险。在 Y30 时，参与者接受了全球和多领域认知评估。我们使用协方差分析来评估 ESRD 风险类别与认知功能的关系，同时控制心血管危险因素。
在 20 年的时间里，427 名参与者（研究人群的 16%）有≥1 次 ESRD 风险暴露。有更多风险发作的个体复合认知功能较低（<0.001）、运动速度较慢（<0.001）和执行功能较差（=0.007）。所有这些关联均独立于社会人口统计学状况和心血管危险因素。
在这项基于人群的纵向研究中，我们表明，成年早期肾功能下降的发作与中年认知表现较差有关。需要研究年轻时期保护肾功能作为保护中年认知功能的潜在策略。
