4.6 Article

Higher Levels of Cystatin C Are Associated with Worse Cognitive Function in Older Adults with Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort Cognitive Study

期刊

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
卷 62, 期 9, 页码 1623-1629

出版社

WILEY-BLACKWELL
DOI: 10.1111/jgs.12986

关键词

cystatin C; cognition; chronic kidney disease

资金

  1. National Institutes of Health (NIH)
  2. National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK 061028, U01DK060980, U01DK060963, U01DK 060902, R01DK069406]
  3. Perelman School of Medicine at the University of Pennsylvania [NIH/NCATS UL1TR000003]
  4. Johns Hopkins University [UL1 TR-000424]
  5. University of Maryland [GCRC M01 RR-16500]
  6. Clinical and Translational Science Collaborative of Cleveland
  7. National Center for Advancing Translational Sciences component of the NIH [UL1TR000439]
  8. NIH Roadmap for Medical Research
  9. Michigan Institute for Clinical and Health Research [UL1TR000433]
  10. University of Illinois at Chicago [CTSA UL1RR029879]
  11. Tulane University Translational Research in Hypertension and Renal Biology [P30GM 103337]
  12. Kaiser NIH/NCRR [UCSF-CTSI UL1 RR-024131]

向作者/读者索取更多资源

ObjectivesTo determine the association between cognition and levels of cystatin C in persons with chronic kidney disease (CKD). DesignProspective observational study. SettingChronic Renal Insufficiency Cohort Cognitive Study. ParticipantsIndividuals with a baseline cognitive assessment completed at the same visit as serum cystatin C measurement (N=821; mean age 64.9, 50.6% male, 48.6% white). MeasurementsLevels of serum cystatin C were categorized into tertiles; cognitive function was assessed using six neuropsychological tests. Scores on these tests were compared across tertiles of cystatin C using linear regression and logistic regression to examine the association between cystatin C level and cognitive performance (1 standard deviation difference from the mean). ResultsAfter multivariable adjustment for age, race, education, and medical comorbidities in linear models, higher levels of cystatin C were associated with worse cognition on the modified Mini-Mental State Examination, Buschke Delayed Recall, Trail-Making Test Part (Trails) A and Part B, and Boston Naming (P<.05 for all). This association remained statistically significant for Buschke Delayed Recall (P=.01) and Trails A (P=.03) after additional adjustment for estimated glomerular filtration rate (eGFR). The highest tertile of cystatin C was associated with greater likelihood of poor performance on Trails A (odds ratio (OR)=2.17, 95% confidence interval (CI)=1.16-4.06), Trails B (OR=1.89, 95% CI=1.09-3.27), and Boston Naming (OR=1.85, 95% CI=1.07-3.19) than the lowest tertile after multivariate adjustment in logistic models. ConclusionIn individuals with CKD, higher serum cystatin C levels were associated with worse cognition and greater likelihood of poor cognitive performance on attention, executive function, and naming. Cystatin C is a marker of cognitive impairment and may be associated with cognition independent of eGFR.

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