Xu Hong, Garcia-Ptacek Sara, Trevisan Marco, Evans Marie, Lindholm Bengt, Eriksdotter Maria, Carrero Juan Jesus
From the Division of Clinical Geriatrics (H.X., S.G.-P., M.E.), Department of Neurobiology, Care Sciences and Society, Department of Medical Epidemiology and Biostatistics (H.X., M.T., J.J.C.), and Division of Renal Medicine and Baxter Novum (M.E., B.L.), Department of Clinical Science, Intervention and Technology, Karolinska Institutet; Department of Internal Medicine (S.G.-P.), Neurology Section, Södersjukhuset; and Theme Aging (S.G.-P., M.E.), Karolinska University Hospital, Stockholm, Sweden.
Neurology. 2021 Jun 14;96(24):e2956-e2965. doi: 10.1212/WNL.0000000000012113.
Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. The aim of this study is to investigate the links among kidney function, kidney function decline, and dementia incidence.
We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis or initiation of dementia treatments) among 329,822 residents of Stockholm who accessed health care during 2006 to 2011, were ≥65 years of age, had no history of dementia, or underwent kidney replacement therapy. We also estimated the rate of eGFR decline among 205,622 residents with repeated eGFR measurements during the first year of observation and investigated its association with subsequent dementia risk.
We detected 18,983 cases of dementia (5.8% of participants) over a median follow-up of 5 years. Dementia incidence rates were progressively higher with lower eGFR: from 6.56/1,000 person-years in those with eGFR of 90 to 104 mL/min to 30.28/1,000 person-years in those with eGFR <30 mL/min. After multivariable adjustment, lower eGFR was associated with a higher dementia risk (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.54-1.91 in eGFR 30-59 mL/min; HR 2.62, 95% CI 1.91-3.58 in eGFR <30 mL/min) compared with eGFR of 90 to 104 mL/min. A steeper decline in eGFR (decline >2 mL/min/1.73 m/y) within 1 year was associated with higher dementia risk. Risk magnitudes were stronger for vascular dementia than for Alzheimer dementia. As many as 10% (95% CI 6%-14%) of dementia cases could be attributed to eGFR <60 mL/min/1.73 m, a proportion higher than that attributed to other dementia risk factors such as cardiovascular disease and diabetes.
Both lower kidney function and steeper kidney function decline are associated with the development of dementia.
基于社区的关于估算肾小球滤过率（eGFR）与痴呆风险之间关联的报告结果相互矛盾。本研究旨在调查肾功能、肾功能下降与痴呆发病率之间的联系。
我们分析了2006年至2011年期间在斯德哥尔摩就医的329,822名居民中eGFR与痴呆风险（定义为新的痴呆诊断或开始痴呆治疗）之间的关联，这些居民年龄≥65岁，无痴呆病史，未接受过肾脏替代治疗。我们还估计了在观察的第一年中进行了重复eGFR测量的205,622名居民的eGFR下降率，并调查了其与随后痴呆风险的关联。
在中位随访5年期间，我们检测到18,983例痴呆病例（占参与者的5.8%）。eGFR越低，痴呆发病率越高：eGFR为90至104 mL/分钟的人群中为6.56/1000人年，而eGFR<30 mL/分钟的人群中为30.28/1000人年。多变量调整后，与eGFR为90至104 mL/分钟相比，较低的eGFR与较高的痴呆风险相关（eGFR为30至59 mL/分钟时，风险比[HR]为1.71，95%置信区间[CI]为1.54 - 1.91；eGFR<30 mL/分钟时，HR为2.62，95%CI为1.91 - 3.58）。1年内eGFR下降更快（下降>2 mL/分钟/1.73平方米/年）与较高的痴呆风险相关。血管性痴呆的风险程度比阿尔茨海默病性痴呆更强。多达10%（95%CI为6% - 14%）的痴呆病例可归因于eGFR<60 mL/分钟/1.73平方米，这一比例高于归因于心血管疾病和糖尿病等其他痴呆风险因素的比例。
较低的肾功能和更快的肾功能下降均与痴呆的发生有关。
