The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

Zijlstra, Laurien E.; Trompet, Stella; Mooijaart, Simon P.; Buren, Marjolijn van; Sattar, Naveed; Stott, David J.; Jukema, J. Wouter

doi:10.1186/s12882-020-01745-5

Cited by 16 publications

(12 citation statements)

References 47 publications

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“…An alternative explanation might be a false positive finding due to multiple comparisons. Evidence of a potential association between severe kidney impairment and cognitive decline was presented in a recent longitudinal review study (n = 5796) by Zijlstra et al [50]. The authors found that in older individuals with vascular burden, only severe kidney dysfunction, correspondent to eGFR < 30 ml/min/1,73 m 2 [7,8], was associated with cognitive decline over time.…”

Section: Discussionmentioning

confidence: 99%

“…The main strength of this longitudinal study is the large number of participants recruited, representing a general population of the (younger) elder population. Another strength is the long follow up time of 6 years, which can be compared to the mean follow up time of 3.2 years, in the review study of Zijlstra et al [50] mentioned above. Yet another strength is the wide panel of cognitive tests used, covering most of the cognitive domains, and also the small test administrator effects on cognitive performance, since only 1.4-3.5 % of the total variation in test scores was explained by the factor attributed to the test administrator [57].…”

Section: Discussionmentioning

confidence: 99%

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Processing speed is affected by early impairment in kidney function in the general elder population

Månsson

Elmståhl

2021

BMC Nephrol

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Background Chronic kidney disease, cardiovascular disease, and cognitive dysfunction are common in the elder population. There is evidence of a connection between these conditions, possibly by a shared vascular pathogenesis. Processing speed is commonly impaired in cerebrovascular disease. Methods The data was obtained from the population based study “Good aging in Skåne” (GÅS), and included 905 individuals (mean age = 68 years). We investigated the impact of impaired kidney function at baseline on the development of dementia, MCI, and impairment in specific cognitive domains at follow up 6 years later, using logistic regression models. Impaired kidney function was defined as GFR < 60 ml/min/1,73 m2. GFR was estimated from creatinine and cystatin C, using the CKD-EPI formula. Function in the cognitive domains learning and memory, language, complex attention, executive function, perceptual-motor, as well as meta-memory, and global cognitive function, was assessed using a neuropsychological test battery consisting of 12 tests. We compared the test results from follow up, with the results obtained at baseline, using linear regression models in order to assess changes in performance in cognitive domains. Results At follow up, 14 and 158 participants had developed dementia and MCI, respectively. We did not find evidence that moderately impaired eGFR at baseline increased the odds of dementia or MCI. A decline in processing speed was associated with impaired kidney function. Conclusions The effect on processing speed could represent early vascular implications on cognition. Even at moderately impaired kidney function, overview of cardiovascular risk factors could potentially prevent further cognitive impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Processing speed is affected by early impairment in kidney function in the general elder population

Månsson

Elmståhl

2021

BMC Nephrol

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“…Cognitive impairment is a well-recognized complication of CKD [ 18 ]. Evidence from the literature found a worsening of cognitive function as the kidney function declines [ 44 , 45 , 46 ]. A recent cohort study using clinical practice research datalink found a co-occurrence of CKD and dementia in the real-world setting [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis

Hussain

Singh

Antony

et al. 2021

JCM

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Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand the association between AKI and dementia risk. A literature search was performed in MEDLINE and Embase databases, from inception to July 2021, to identify epidemiological studies reporting the association between AKI and dementia risk. Title and abstract followed by the full-text of retrieved articles were screened, data were extracted, and quality was assessed, using the Newcastle–Ottawa scale by two investigators independently. The primary outcome was to compute the pooled risk of dementia in AKI patients. Subgroup analysis was also performed based on age and co-morbidities. Certainty of evidence was assessed using the GRADE approach. Statistical analysis was performed using Review Manager 5.4 software. Four studies (cohort (n = 3) and case–control (n = 1)) with a total of 429,211 patients, of which 211,749 had AKI, were identified. The mean age of the patients and the follow-up period were 64.15 ± 16.09 years and 8.9 years, respectively. Included studies were of moderate to high quality. The pooled estimate revealed a significantly higher risk of dementia in AKI patients with an overall relative risk/risk ratio (RR) of 1.92 (95% CI: 1.52–2.43), p ≤ 0.00001. Dementia risk increases by 10% with one year increase in age with an RR of 1.10 (95% CI: 1.09–1.11), p < 0.00001. Subgroup analysis based on stroke as a co-morbid condition also revealed significantly higher dementia risk in AKI patients (RR 2.30 (95% CI: 1.62–3.28), p = 0.009). All-cause mortality risk was also significantly higher in AKI patients with dementia with a pooled RR of 2.11 (95% CI: 1.20–3.70), p = 0.009. The strength of the evidence was of very low certainty as per the GRADE assessment. Patients with AKI have a higher risk of dementia. Further large epidemiological studies are needed to confirm the mechanistic association.

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“…Cognitive impairment is increasingly prevalent in aging and multi-morbid populations. Chronic kidney disease (CKD) is also increasing in prevalence and after correcting for shared vascular risk factors within an aging multi-morbid population, advanced CKD is independently associated with cognitive impairment ( 1 ). Kidney replacement therapies (KRT) with dialysis or kidney transplantation carry a cognitive burden in themselves, from the lifestyle demands and healthcare interactions demands on patients through to marked physiological stressors and unique cardiovascular instability.…”

Section: Introductionmentioning

confidence: 99%

“Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article

et al. 2021

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Cognitive impairment is independently associated with kidney disease and increases in prevalence with declining kidney function. At the stage where kidney replacement therapy is required, with dialysis or transplantation, cognitive impairment is up to three times more common, and can present at a younger age. This is not a new phenomenon. The cognitive interactions of kidney disease are long recognized from historical accounts of uremic encephalopathy and so-called “dialysis dementia” to the more recent recognition of cognitive impairment in those undergoing kidney replacement therapy (KRT). The understanding of cognitive impairment as an extra-renal complication of kidney failure and effect of its treatments is a rapidly developing area of renal medicine. Multiple proposed mechanisms contribute to this burden. Advanced vascular aging, significant multi-morbidity, mood disorders, and sleep dysregulation are common in addition to the disease-specific effects of uremic toxins, chronic inflammation, and the effect of dialysis itself. The impact of cognitive impairment on people living with kidney disease is vast ranging from increased hospitalization and mortality to decreased quality of life and altered decision making. Assessment of cognition in patients attending for renal care could have benefits. However, in the context of a busy clinical service, a pragmatic approach to assessing cognitive function is necessary and requires consideration of the purpose of testing and resources available. Limited evidence exists to support treatments to mitigate the degree of cognitive impairment observed, but promising interventions include physical or cognitive exercise, alteration to the dialysis treatment and kidney transplantation. In this review we present the history of cognitive impairment in those with kidney failure, and the current understanding of the mechanisms, effects, and implications of impaired cognition. We provide a practical approach to clinical assessment and discuss evidence-supported treatments and future directions in this ever-expanding area which is pivotal to our patients' quality and quantity of life.

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The association of kidney function and cognitive decline in older patients at risk of cardiovascular disease: a longitudinal data analysis

Cited by 16 publications

References 47 publications

Processing speed is affected by early impairment in kidney function in the general elder population

Processing speed is affected by early impairment in kidney function in the general elder population

Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis

“Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article

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