慢性肾脏病患者的认知功能与肾小球滤过率相关：CKD-REIN队列研究结果
Cognitive performance is associated with glomerular filtration rate in patients with chronic kidney disease: results from the CKD-REIN cohort.
作者信息
Pépin Marion, Levassort Hélène, Boucquemont Julie, Lambert Oriane, Alencar de Pinho Natalia, Turinici Monica, Helmer Catherine, Metzger Marie, Cheddani Lynda, Frimat Luc, Combe Christian, Fouque Denis, Laville Maurice, Ayav Carole, Liabeuf Sophie, Jacquelinet Christian, Teillet Laurent, Stengel Bénédicte, Massy Ziad A
机构信息
Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.
出版信息
J Neurol Neurosurg Psychiatry. 2023 Jun;94(6):457-466. doi: 10.1136/jnnp-2022-330347. Epub 2023 Jan 24.
BACKGROUND
Chronic kidney disease (CKD) is associated with cognitive impairment in general population. We assessed the association between kidney and cognitive functions in patients with CKD and the influence of cardiovascular (CV) risk factors, and depression on this association.
METHODS
The CKD-Renal Epidemiology and Information Network cohort included 3033 patients with CKD stages 3-4, followed for 5 years. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and estimated glomerular filtration rate (eGFR) with the CKD-Epidemiology Collaboration equation-creatinin formula. Evolution of the MMSE score over time and its association with baseline eGFR were investigated with linear mixed models. We assessed the risk of incident cognitive outcome (hospitalisation or death with relevant International Classification of Disease-10 codes), with a Cox proportional hazard model.
RESULTS
The mean age was 66.8, the mean eGFR was 33 mL/min/1.73 m and 387 patients (13.0%) had an MMSE score below 24 at baseline. A 10 mL/min/1.73 m decrement of baseline eGFR was associated with a mean MMSE decrease of 0.12 (95% CI 0.04 to 0.19) after adjustment for demographic characteristics, depression, CV risk factors and disease; but baseline eGFR was not associated with MMSE temporal evolution. HR for cognitive outcome during follow-up (median 2.01 years) associated with a 10 mL/min/1.73 m decrement of baseline eGFR was 1.35 (1.07, 1.70) (p=0.01) after adjustment.
CONCLUSIONS
In patients with CKD, lower eGFR was associated with worse cognitive performance and incident cognitive events, independently of demographics, CV risk factors and depression.
TRIAL REGISTRATION NUMBER
NCT03381950.
背景
慢性肾脏病（CKD）与普通人群的认知障碍相关。我们评估了CKD患者肾脏功能与认知功能之间的关联，以及心血管（CV）危险因素和抑郁对这种关联的影响。
方法
CKD-肾脏流行病学和信息网络队列包括3033例3-4期CKD患者，随访5年。使用简易精神状态检查表（MMSE）评估认知功能，使用CKD-流行病学协作方程-肌酐公式估算肾小球滤过率（eGFR）。使用线性混合模型研究MMSE评分随时间的变化及其与基线eGFR的关联。我们使用Cox比例风险模型评估发生认知结局（伴有相关国际疾病分类-10编码的住院或死亡）的风险。
结果
平均年龄为66.8岁，平均eGFR为33 mL/min/1.73 m²，387例患者（13.0%）在基线时MMSE评分低于24分。在调整人口统计学特征、抑郁、CV危险因素和疾病后，基线eGFR每降低10 mL/min/1.73 m²与MMSE平均降低0.12（95%CI 0.04至0.19）相关；但基线eGFR与MMSE的时间演变无关。在调整后，与基线eGFR每降低10 mL/min/1.73 m²相关的随访期间（中位时间2.01年）认知结局的HR为1.35（1.07，1.70）（p=0.01）。
结论
在CKD患者中，较低的eGFR与较差的认知表现和认知事件发生相关，独立于人口统计学、CV危险因素和抑郁。
试验注册号
NCT03381950。
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