肾功能与老年人的认知和情绪有关吗？：欧洲老年人慢性肾脏病筛查研究（SCOPE）。
Is kidney function associated with cognition and mood in late life? : The Screening for CKD among Older People across Europe (SCOPE) study.
机构信息
Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy.
出版信息
BMC Geriatr. 2020 Oct 2;20(Suppl 1):297. doi: 10.1186/s12877-020-01707-4.
BACKGROUND
Chronic kidney disease (CKD), cognitive impairment and depression share common risk factors. Previous studies did not investigate the possible association between kidney function and cognitive and mood disorders in older persons in a broad range of kidney function. The present study explored associations between kidney function, cognition and mood in outpatients of 75 years and over.
METHODS
Baseline data of 2252 participants of the SCOPE study, an international multicenter cohort observational study,were used in which community-dwelling persons of 75 years and over were enrolled to screen for CKD Kidney function was estimated with the BIS1-eGFR equation, cognition was assessed with the Mini-Mental State Examination (MMSE) and mood with the Geriatric Depression Scale 15 items (GDS-15). Characteristics were compared across stages of CKD. Mean eGFR values were also compared across categories of MMSE (< 24, 24-26, ≥27) and between groups with high and low score on the GDS-15 (> 5/≤5).
RESULTS
In total, 63% of the population had an eGFR < 60 mL/min. In advanced stages of CKD, participants were older and more often men than in earlier stages (p < 0.001). Cardiovascular diseases and diabetes mellitus were more often found in those in advanced stages of CKD (p < 0.001), and also cumulative comorbidity scores were higher than in those in earlier stages (p < 0.001). Median MMSE was 29 in CKD stage 1-2 and 3, and 30 in CKD stage 4, whereas median GDS-15 score was 2 in all stages of CKD. Mean values of eGFR did not differ across categories of MMSE or between groups with high and low score on the GDS-15. Stratification for albuminuria did not change these results.
CONCLUSIONS
Older persons in more advanced stages of CKD did not have lower cognitive scores or higher rates of depressive symptoms than older persons in earlier stages. Future longitudinal studies might give information on the possible effect of kidney function on cognition and mood in late life.
TRIAL REGISTRATION
This study was registered prospectively on 25th February 2016 at clinicaltrials.gov ( NCT02691546 ).
背景
慢性肾脏病（CKD）、认知障碍和抑郁共有的危险因素。先前的研究并未在广泛的肾功能范围内调查肾功能与老年人认知和情绪障碍之间的可能关联。本研究探讨了 75 岁及以上门诊患者肾功能、认知和情绪之间的关联。
方法
使用 SCOPE 研究的基线数据，这是一项国际多中心队列观察性研究，其中纳入了社区居住的 75 岁及以上人群以筛查 CKD。肾功能采用 BIS1-eGFR 方程估计，认知采用简易精神状态检查（MMSE）评估，情绪采用 15 项老年抑郁量表（GDS-15）评估。比较了不同 CKD 阶段的特征。还比较了 MMSE（<24、24-26、≥27）和 GDS-15（>5/≤5）得分高/低组之间的平均 eGFR 值。
结果
共有 63%的人群 eGFR<60mL/min。在 CKD 的晚期阶段，与早期阶段相比，参与者年龄更大，男性更多（p<0.001）。晚期 CKD 患者更常患有心血管疾病和糖尿病（p<0.001），累积合并症评分也高于早期（p<0.001）。CKD 1-2 和 3 期的 MMSE 中位数为 29，CKD 4 期为 30，而 CKD 各期的 GDS-15 中位数为 2。MMSE 各分类的 eGFR 平均值或 GDS-15 得分高/低组之间的 eGFR 平均值均无差异。白蛋白尿分层并未改变这些结果。
结论
与早期 CKD 患者相比，晚期 CKD 患者的认知评分并没有降低，抑郁症状的发生率也没有更高。未来的纵向研究可能会提供有关肾功能对晚年认知和情绪影响的信息。
试验注册
本研究于 2016 年 2 月 25 日在 clinicaltrials.gov 上进行了前瞻性注册（NCT02691546）。
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