Cheung Katharine L, Renteria Miguel Arce, Callas Peter W, Tamura Manjula Kurella, Gutierrez Orlando M, Cushman Mary, LaMantia Michael
University of Vermont College of Medicine, Burlington, VT, USA.
University of Vermont, Center on Aging, Burlington, USA.
J Gen Intern Med. 2025 Jan 22. doi: 10.1007/s11606-025-09366-0.
Chronic kidney disease (CKD) is associated with incident cognitive impairment (ICI) and disproportionately affects older adults and Black persons.
To determine (1) whether age or race differences exist in the association of CKD and ICI and (2) whether cognitive trajectories differ in people with and without CKD.
Nationwide cohort study.
A total of 22,435 Black and White adults age ≥ 45 years without baseline cognitive impairment.
Creatinine-cystatin C-based eGFR and albumin-to-creatinine ratio (ACR). Six-item screener (SIS) of global cognition every 6 months, three cognitive domain tests (memory, semantic, and letter fluencies) every 2 years for 10 years. Logistic regression for risk of CI and latent growth curve models for trajectory analysis.
Participants were 56% female, 37% Black, 56% hypertensive, and 19% had diabetes. Overall, 13% (n = 2959) developed ICI over 10 years. In mid-life (age 45- < 65), the OR (95% CI) of ICI for eGFR < 45 vs eGFR ≥ 90 was 1.9 (1.2, 3.0); in late-life (≥ 65), the OR was 0.9 (0.7, 1.1), p interaction < 0.001. For ACR > 300 vs ACR < 10, in mid-life and late-life, the ORs were 1.6 (1.0, 2.6) and 1.0 (0.7, 1.4), p interaction 0.02. Compared to those with eGFR ≥ 60, eGFR < 60 was associated with lower initial cognitive domains scores, worse in mid-life than late-life, but the slopes did not differ. Compared to ACR < 30, ACR ≥ 30 had lower initial cognitive domain scores, which were similar in mid and late-life, and a steeper decline for memory scores. No differences by race were observed.
Kidney disease was more strongly linked to cognitive impairment in mid-life than in late-life. Albuminuria was associated with steeper decline in memory function, especially in mid-life.
NIGMS.
慢性肾脏病（CKD）与新发认知障碍（ICI）相关，且对老年人和黑人的影响尤为严重。
确定（1）CKD与ICI的关联中是否存在年龄或种族差异，以及（2）患有和未患有CKD的人群认知轨迹是否不同。
全国性队列研究。
共有22435名年龄≥45岁、无基线认知障碍的黑人和白人成年人。
基于肌酐-胱抑素C的估算肾小球滤过率（eGFR）和白蛋白与肌酐比值（ACR）。每6个月进行一次六项简易认知筛查（SIS）评估整体认知，每2年进行一次三项认知领域测试（记忆、语义和字母流畅性），持续10年。采用逻辑回归分析CI风险，采用潜在增长曲线模型进行轨迹分析。
参与者中56%为女性，37%为黑人，56%患有高血压，19%患有糖尿病。总体而言，13%（n = 2959）在10年内发生了ICI。在中年（45-<65岁），eGFR<45与eGFR≥90相比，ICI的比值比（OR，95%置信区间）为1.9（1.2，3.0）；在老年（≥65岁），OR为0.9（0.7，1.1），交互作用p<0.001。对于ACR>300与ACR<10，在中年和老年，OR分别为1.6（1.0，2.6）和1.0（0.7，1.4），交互作用p = 0.02。与eGFR≥60的人相比，eGFR<60与较低的初始认知领域得分相关，中年比老年更差，但斜率无差异。与ACR<30相比，ACR≥30的初始认知领域得分较低，中年和老年相似，且记忆得分下降更陡峭。未观察到种族差异。
与老年相比，中年时肾脏疾病与认知障碍的关联更强。蛋白尿与记忆功能下降更陡峭相关，尤其是在中年。
美国国立综合医学科学研究所（NIGMS）
