Wu Lei-Yun, Lu Yuan-Yuan, Zheng Shuang-Shuang, Cui Ya-Dong, Lu Jie, Zhang Ai-Hua
Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China.
Front Neurol. 2024 Jun 4;15:1347682. doi: 10.3389/fneur.2024.1347682. eCollection 2024.
Cognitive impairment and brain atrophy are common in chronic kidney disease patients. It remains unclear whether differences in renal function, even within normal levels, influence hippocampal volume (HCV) and cognition. We aimed to investigate the association between estimated glomerular filtration rate (eGFR), HCV and cognition in outpatients.
This single-center retrospective study enrolled 544 nonrenal outpatients from our hospital. All participants underwent renal function assessment and 3.0 T magnetic resonance imaging (MRI) in the same year. HCV was also measured, and cognitive assessments were obtained. The correlations between eGFR, HCV, and cognitive function were analyzed. Logistic regression analysis was performed to identify the risk factors for hippocampal atrophy and cognitive impairment. Receiver-operator curves (ROCs) were performed to find the cut-off value of HCV that predicts cognitive impairment.
The mean age of all participants was 66.5 ± 10.9 years. The mean eGFR of all participants was 88.5 ± 15.1 mL/min/1.73 m. eGFR was positively correlated with HCV and with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. Univariate and multivariate logistic regression analysis showed Age ≥ 65 years, eGFR < 75 mL/min/1.73 m, Glucose ≥6.1 mmol/L and combined cerebral microvascular diseases were independent risk factors for hippocampal atrophy and Age ≥ 65 years, left hippocampal volume (LHCV) <2,654 mm were independent risk factors for cognitive impairment in outpatients. Although initial unadjusted logistic regression analysis indicated that a lower eGFR (eGFR < 75 mL/min/1.73 m) was associated with poorer cognitive function, this association was lost after adjusting for confounding variables. ROC curve analysis demonstrated that LHCV <2,654 mm had the highest AUROC [(0.842, 95% CI: 0.808-0.871)], indicating that LHCV had a credible prognostic value with a high sensitivity and specificity for predicting cognitive impairment compared with age in outpatients.
Higher eGFR was associated with higher HCV and better cognitive function. eGFR < 75 mL/min/1.73 m was an independent risk factor for hippocampal atrophy after adjusting for age. It is suggested that even eGFR < 75 mL/min/1.73 m, lower eGFR may still be associated with hippocampal atrophy, which is further associated with cognitive impairment. LHCV was a favorable prognostic marker for predicting cognitive impairment rather than age.
认知障碍和脑萎缩在慢性肾脏病患者中很常见。肾功能的差异，即使在正常水平范围内，是否会影响海马体积（HCV）和认知仍不清楚。我们旨在调查门诊患者中估计肾小球滤过率（eGFR）、HCV与认知之间的关联。
这项单中心回顾性研究纳入了我院544名非肾脏门诊患者。所有参与者在同一年接受了肾功能评估和3.0T磁共振成像（MRI）检查。还测量了HCV，并进行了认知评估。分析了eGFR、HCV与认知功能之间的相关性。进行逻辑回归分析以确定海马萎缩和认知障碍的危险因素。绘制受试者工作特征曲线（ROC）以找出预测认知障碍的HCV临界值。
所有参与者的平均年龄为66.5±10.9岁。所有参与者的平均eGFR为88.5±15.1mL/min/1.73m²。eGFR与HCV、简易精神状态检查表（MMSE）和蒙特利尔认知评估（MoCA）评分呈正相关。单因素和多因素逻辑回归分析显示，年龄≥65岁、eGFR<75mL/min/1.73m²、血糖≥6.1mmol/L以及合并脑微血管疾病是海马萎缩的独立危险因素，年龄≥65岁、左侧海马体积（LHCV）<2654mm³是门诊患者认知障碍的独立危险因素。尽管最初未经调整的逻辑回归分析表明较低的eGFR（eGFR<75mL/min/1.73m²）与较差的认知功能相关，但在调整混杂变量后这种关联消失了。ROC曲线分析表明，LHCV<2654mm³的曲线下面积（AUROC）最高[（0.842，95%CI：0.808 - 0.871）]，表明与年龄相比，LHCV对门诊患者认知障碍具有较高的敏感性和特异性，具有可靠的预后价值。
较高的eGFR与较高的HCV和较好的认知功能相关。在调整年龄后，eGFR<75mL/min/1.73m²是海马萎缩的独立危险因素。提示即使eGFR<75mL/min/1.73m²，较低的eGFR仍可能与海马萎缩相关，进而与认知障碍相关。LHCV是预测认知障碍的良好预后标志物，而非年龄。
