NDT Advance Access originally published online on March 18, 2009
Nephrology Dialysis Transplantation 2009 24(8):2446-2452; doi:10.1093/ndt/gfp107
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Chronic kidney disease, creatinine and cognitive functioning
1 Department of Psychology, Graduate School of Biomedical Sciences, University of Maine, Orono, ME, USA 2 Department of Psychology, University of Maine, Orono, ME, USA 3 Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, USA 4 Departments of Medicine and Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
Correspondence and offprint requests to: Merrill F. Elias; E-mail: mfelias{at}aol.com
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Abstract |
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Background. Non-dialysis-dependent chronic kidney disease (CKD) is related to cognitive impairment. Previous studies have not explored the extent of impairment across multiple cognitive domains. We examined the range of specific cognitive abilities affected by CKD and whether the associations of CKD with cognition were eliminated by statistical control for cardiovascular disease correlates of CKD.
Methods. We performed a community-based cross-sectional study with 923 individuals free from dementia and end-stage renal disease. Two groups were defined based on estimated glomerular filtration rate (eGFR): eGFR<60 mL/min/1.73 m2 versus eGFR 
60 mL/min/1.73 m2. Outcome measures were scores from multiple clinical tests of specific cognitive abilities. The GFR classifications and serum creatinine levels were related to measures of cognitive performance using logistic and linear regression analyses with three sets of covariates: (1) basic (age, education, gender and race); (2) basic+risk factors for cardiovascular disease (CVD) and (3) basic+risk factors for CVD+stroke.
Results. An eGFR <60 mL/min/1.73 m2 was present in 142 (15.4%) individuals; the mean (SD) eGFR in this subgroup was 49.7 (10.7). CKD was related to lower cognitive performance despite adjustment for CVD risk factors (CVD-RF). Adjusting for CVD-RF and stroke, odds ratios and 95% confidence intervals associated with performing in the lowest quartile of the distribution of the Global, Visual–Spatial Organization/Memory and Scanning and Tracking scores for the eGFR < 60 group were 1.97 (1.25, 3.10); 1.88 (1.21, 2.93) and 1.83 (1.56, 2.87), P < 0.01 with eGFR 60 group as the reference group.
Conclusions. Global performance and specific cognitive functions are negatively affected early in CKD. Targeted screening for cognitive deficits in kidney disease patients early in their disease course may be warranted.
Keywords: cardiovascular disease; chronic kidney disease; cognitive performance; serum creatinine
Received for publication: 6. 8.08
Accepted in revised form: 20. 2.09
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