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Abstract
Objective To test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife.
Methods We included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35 years, 54% women, 45% Black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at year (Y) 10 through Y30. At each visit, moderate/high risk of ESRD according to the Kidney Disease: Improving Global Outcomes guidelines (estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin-to-creatinine ratio >30 mg/g) was defined, totaled over examinations, and categorized into 0 episodes, 1 episode, and >1 episodes of ESRD risk. At Y30, participants underwent global and multidomain cognitive assessment. We used analysis of covariance to assess the association of ESRD risk categories with cognitive function, controlling for cardiovascular risk factors.
Results Over the course of 20 years, 427 participants (16% of the study population) had ≥1 episodes of ESRD risk exposure. Individuals with more risk episodes had lower composite cognitive function (p < 0.001), psychomotor speed (p < 0.001), and executive function (p = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors.
Conclusions In this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to preserve cognitive function in midlife.
Glossary
- ACR=
- albumin-to-creatinine ratio;
- BLSA=
- Baltimore Longitudinal Study of Aging;
- CARDIA=
- Coronary Artery Risk Development in Young Adults;
- CKD=
- chronic kidney disease;
- DSST=
- Digit Symbol Substitution Test;
- eGFR=
- estimated glomerular filtration rate;
- ESRD=
- end-stage renal disease;
- KDIGO=
- Kidney Disease: Improving Global Outcomes;
- MoCA=
- Montreal Cognitive Assessment;
- RAVLT=
- Rey Auditory Verbal Learning Test;
- Y=
- year
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received November 12, 2019.
- Accepted in final form May 27, 2020.
- © 2020 American Academy of Neurology
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