Bano Ruqiyya, Clouston Sean A P, Mann Frank, Khan Babar A, Carr Melissa, Hedayati S Susan, Luft Benjamin J, Koraishy Farrukh M
Department of Medicine, Division of Nephrology, Stony Brook University, Stony Brook, NY, USA, 11794.
Stony Brook WTC Health & Wellness Program, Commack, NY 11725.
Kidney360. 2025 Jun 25. doi: 10.34067/KID.0000000880.
Emerging evidence suggests that better cognition is associated with a lower risk of chronic kidney disease (CKD). However, whether early-onset cognitive impairment (CI) at baseline is linked to rapid estimated glomerular filtration rate (eGFR) decline or incident CKD remains unclear.
We conducted a prospective cohort study of 5,761 World Trade Center (WTC) responders (mean age: 53.8 ± 7.9 years) without CKD at baseline, followed for a mean of 4.2 ± 1.9 years. CI was defined as a Montreal Cognitive Assessment (MoCA) score ≤23, with a subgroup analysis for baseline dementia (MoCA ≤18). Primary outcomes included annual eGFR change and rapid eGFR decline (< -5 mL/min/1.73 m2 per year). The secondary outcome was incident CKD (eGFR <60 mL/min/1.73 m2 or diagnosis code). Multivariable Cox proportional hazards models and linear regressions were used for binary and continuous outcomes, respectively. Sensitivity analyses included looking at the effect of baseline mild cognitive impairment (MCI) (MoCA score 19-23), propensity matching for demographics, baseline age <60 years, removal of baseline post-traumatic stress disorder (PTSD)/ depression or baseline head trauma/stroke/cardiovascular disease and after exclusion of those who died during follow-up.
At baseline, 1,446 (25%) individuals had CI, while 89 (2%) had dementia. The mean baseline eGFR was 91.1 mL/min/1.73 m2, with an overall decline of -1.2 mL/min/1.73 m2 per year. Rapid eGFR decline occurred in 550 (10%) individuals. After adjusting for age, sex, race/ethnicity, comorbidities, WTC exposure, screened PTSD, and baseline eGFR, CI and dementia were significantly associated with rapid eGFR decline (adjusted hazard ratio [aHR]: 1.63 and 2.42, respectively; both p < 0.001) and faster annual eGFR decline. Findings were consistent across all sensitivity analyses. Additionally, 248 (4%) individuals developed incident CKD. Both baseline CI (aHR: 1.72, p < 0.001) and dementia (aHR: 2.77, p = 0.010) were significantly associated with incident CKD.
Among middle-aged individuals without CKD, early-onset cognitive impairment was independently associated with rapid eGFR decline and incident CKD. These findings warrant validation in other cohorts.
新出现的证据表明，较好的认知功能与较低的慢性肾脏病（CKD）风险相关。然而，基线时的早发性认知障碍（CI）是否与估计肾小球滤过率（eGFR）快速下降或新发CKD相关仍不清楚。
我们对5761名世界贸易中心（WTC）应急人员（平均年龄：53.8±7.9岁）进行了一项前瞻性队列研究，这些人员在基线时无CKD，平均随访4.2±1.9年。CI被定义为蒙特利尔认知评估（MoCA）评分≤23分，并对基线痴呆（MoCA≤18分）进行亚组分析。主要结局包括每年eGFR变化和eGFR快速下降（每年<-5 mL/min/1.73 m²）。次要结局是新发CKD（eGFR<60 mL/min/1.73 m²或诊断编码）。多变量Cox比例风险模型和线性回归分别用于二元和连续结局。敏感性分析包括观察基线轻度认知障碍（MCI）（MoCA评分19 - 23分）的影响、对人口统计学进行倾向匹配、基线年龄<60岁、排除基线创伤后应激障碍（PTSD）/抑郁症或基线头部外伤/中风/心血管疾病以及排除随访期间死亡的人员。
在基线时，1446名（25%）个体有CI，而89名（2%）有痴呆。平均基线eGFR为91.1 mL/min/1.73 m²，每年总体下降-1.2 mL/min/1.73 m²。550名（10%）个体出现eGFR快速下降。在调整年龄、性别、种族/民族、合并症、WTC暴露、筛查的PTSD和基线eGFR后，CI和痴呆与eGFR快速下降显著相关（调整后风险比[aHR]：分别为1.63和2.42；均p<0.001）以及每年eGFR下降更快。所有敏感性分析的结果均一致。此外，248名（4%）个体发生了新发CKD。基线CI（aHR：1.72，p<0.001）和痴呆（aHR：2.77，p = 0.010）均与新发CKD显著相关。
在无CKD的中年个体中，早发性认知障碍与eGFR快速下降和新发CKD独立相关。这些发现需要在其他队列中进行验证。
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