Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Nephrol Dial Transplant. 2022 Oct 19;37(11):2180-2189. doi: 10.1093/ndt/gfab338.
Cognitive impairment is common among persons with chronic kidney disease (CKD), due in part to reduced kidney function. Given that physical activity (PA) is known to mitigate cognitive decline, we examined whether associations between CKD stage and global/domain-specific cognitive function differ by PA.
We leveraged 3223 participants (≥60 years of age) enrolled in National Health and Nutrition Examination Survey (NHANES, 2011-2014), with at least one measure of objective cognitive function [immediate recall (CERAD-WL), delayed recall (CERAD-DR), verbal fluency (AF), executive function/processing speed (DSST), global (average of four tests) or self-perceived memory decline (SCD)]. We quantified the association between CKD stage {no CKD: estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2 and albuminuria [albumin:creatinine ratio (ACR)] <30 mg/g; stages G1-G3: eGFR ≥60 mL/min/1.73 m2 and ACR ≥30 mg/g or eGFR 30-59 mL/min/1.73 m2; stages G4 and G5: eGFR <30 mL/min/1.73 m2} and cognitive function using linear regression (objective measures) and logistic regression (SCD), accounting for sampling weights for nationally representative estimates. We tested whether associations differed by PA [Global Physical Activity Questionnaire, high PA ≥600 metabolic equivalent of task (MET) · min/week versus low PA <600 MET · min/week] using a Wald test.
Among NHANES participants, 34.9% had CKD stages G1-G3, 2.6% had stages G4 and G5 and 50.7% had low PA. CKD stages G4 and G5 were associated with lower global cognitive function {difference = -0.38 standard deviation [SD] [95% confidence interval (CI) -0.62 to -0.15]}. This association differed by PA (Pinteraction = 0.01). Specifically, among participants with low PA, those with CKD stages G4 and G5 had lower global cognitive function [difference = -0.57 SD (95% CI -0.82 to -0.31)] compared with those without CKD. Among those with high PA, no difference was found [difference = 0.10 SD (95% CI -0.29-0.49)]. Similarly, the CKD stage was only associated with immediate recall, verbal fluency, executive function and processing speed among those with low PA; no associations were observed for delayed recall or self-perceived memory decline.
CKD is associated with lower objective cognitive function among those with low but not high PA. Clinicians should consider screening older patients with CKD who have low PA for cognitive impairment and encourage them to meet PA guidelines.
由于肾功能下降，慢性肾脏病（CKD）患者普遍存在认知障碍。鉴于体力活动（PA）已知可减轻认知能力下降，我们研究了 CKD 分期与全球/特定领域认知功能之间的关联是否因 PA 而有所不同。
我们利用了 3223 名（≥60 岁）参加国家健康和营养检查调查（NHANES，2011-2014 年）的参与者，这些参与者至少有一项客观认知功能测量结果[即时回忆（CERAD-WL）、延迟回忆（CERAD-DR）、语言流畅性（AF）、执行功能/处理速度（DSST）、全球（四项测试的平均值）或自我感知记忆减退（SCD）]。我们使用线性回归（客观测量）和逻辑回归（SCD）来评估 CKD 分期{无 CKD：估计肾小球滤过率[eGFR]≥60 mL/min/1.73 m2 和白蛋白尿[白蛋白：肌酐比（ACR）]＜30 mg/g；G1-G3 期：eGFR≥60 mL/min/1.73 m2 和 ACR≥30 mg/g 或 eGFR 30-59 mL/min/1.73 m2；G4 和 G5 期：eGFR＜30 mL/min/1.73 m2}与认知功能之间的关联，并针对全国代表性估计值使用抽样权重进行了调整。我们使用 Wald 检验测试了关联是否因 PA[全球体力活动问卷，高 PA≥600 代谢当量任务（MET）·分钟/周与低 PA＜600 MET·分钟/周]而有所不同。
在 NHANES 参与者中，34.9%患有 CKD G1-G3 期，2.6%患有 G4 和 G5 期，50.7%的人 PA 较低。CKD G4 和 G5 期与全球认知功能较低相关{差异=-0.38 标准差[SD] [95%置信区间（CI）-0.62 至-0.15]}。这种关联因 PA 而异（P 交互=0.01）。具体来说，在 PA 较低的参与者中，与无 CKD 相比，患有 CKD G4 和 G5 的参与者的全球认知功能较低[差异=-0.57 SD（95%CI-0.82 至-0.31)]。在 PA 较高的参与者中，未发现差异[差异=0.10 SD（95%CI-0.29 至 0.49)]。同样，只有在 PA 较低的参与者中，CKD 分期才与即时回忆、语言流畅性、执行功能和处理速度相关；在延迟回忆或自我感知记忆减退方面未观察到关联。
在 PA 较低的患者中，CKD 与较低的客观认知功能有关，但在 PA 较高的患者中没有关联。临床医生应考虑对患有低 PA 的 CKD 老年患者进行认知障碍筛查，并鼓励他们达到 PA 指南。
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