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CKD Associates with Cognitive Decline

Minesh Khatri^*, Thomas Nickolas, Yeseon P. Moon, Myunghee C. Paik, Tatjana Rundek, Mitchell S. V. Elkind^||, Ralph L. Sacco and Clinton B. Wright

*Department of Internal Medicine, University of Washington, Seattle, Washington;
Division of Nephrology, Department of Medicine, and
^||Division of Stroke, Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, New York;
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; and
Divisions of Stroke and Cognitive Disorders and the Evelyn F. McKnight Center for Age-Related Memory Loss, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida

Correspondence: Dr. Clinton Wright, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, CRB 1349, Miami, FL 33136. Phone: 305-243-1664; Fax: 305-243-1680; E-mail: cwright{at}med.miami.edu

Received for publication October 20, 2008. Accepted for publication July 2, 2009.

Cognitive impairment and chronic kidney disease (CKD) will become increasingly prevalent in the aging US population. Although evidence exists that CKD is a risk factor for cognitive decline, longitudinal studies are limited and largely have excluded ethnically diverse populations. The Northern Manhattan Study includes a population-based, prospective, stroke-free cohort. We assessed global cognitive function annually using the modified Telephone Interview for Cognitive Status (TICS-m) and estimated kidney function using Cockcroft–Gault creatinine clearance (CCl), Modification of Diet in Renal Disease estimated GFR (eGFR), and serum creatinine (sCr). We examined the association between CKD and change in TICS-m scores over time, adjusting for sociodemographic and vascular risk factors. Of 2172 subjects (mean age 71.5 yr, mean follow-up 2.9 yr), 59% were Hispanic, 20% were black, and 63% were women. Participants with a CCl <60 ml/min and those with a CCl between 60 and 90 ml/min performed significantly worse on the TICS-m over time than those with a CCl >90 ml/min, adjusting for potential confounders. Our results were similar when we used eGFR or sCr to estimate kidney function. In conclusion, decreased kidney function associates with greater cognitive decline, even in those with mild CKD. Kidney disease may represent a novel mechanism leading to cognitive impairment and a target for early intervention.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673