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Chronic Kidney Disease and Cognitive Impairment in the Elderly: The Health, Aging, and Body Composition Study

Manjula Kurella^*, Glenn M. Chertow^*, Linda F. Fried, Steven R. Cummings^*,, Tamara Harris, Eleanor Simonsick, Suzanne Satterfield^||, Hilsa Ayonayon^* and Kristine Yaffe^*

^* Divisions of Nephrology, Neurology, and Psychiatry, Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; San Francisco Coordinating Center and California Pacific Medical Center Research Institute, San Francisco, California; Intramural Research Program and the Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland; and ^|| Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, Tennessee

Address correspondence to: Dr. Manjula Kurella, Division of Nephrology, University of California San Francisco, Laurel Heights, 3333 California Street, Suite 430, San Francisco, CA 94118-1211. Phone: 415-476-2173; Fax: 415-476-3381; Email: kurella{at}itsa.ucsf.edu

Received for publication January 3, 2005. Accepted for publication March 31, 2005.

Previous studies suggest a link between chronic kidney disease (CKD) and cognitive impairment. Whether the longitudinal course of cognitive impairment differs among people with or without CKD is unknown. Data collected in 3034 elderly individuals who participated in the Health, Aging, and Body Composition study were analyzed. Cognitive function was assessed with the Modified Mini-Mental State Exam (3MS) at baseline and then 2 and 4 yr after baseline. Cognitive impairment was defined as a 3MS score <80 or a decline in 3MS >5 points after 2 or 4 yr of follow-up among participants with baseline 3MS scores 80. Participants with CKD, defined as an estimated GFR (eGFR) <60 ml/min per 1.73 m², were further divided into two eGFR strata. Unadjusted mean baseline 3MS scores and mean declines in 3MS scores over 4 yr were significantly more pronounced for participants with lower baseline eGFR. More advanced stages of CKD were associated with an increased risk for cognitive impairment: Odds ratio (OR) 1.32 (95% confidence interval [CI] 1.03 to 1.69) and OR 2.43 (95% CI, 1.38 to 4.29) for eGFR 45 to 59 ml/min per 1.73 m² and <45 ml/min per 1.73 m², respectively, adjusted for case mix, baseline 3MS scores, and other potential confounders. CKD is associated with an increased risk for cognitive impairment in the elderly that cannot be fully explained by other well-established risk factors. Studies aimed at understanding the mechanism(s) responsible for cognitive impairment in CKD and efforts to interrupt this decline are warranted.

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