Decline in kidney function over the course of adulthood and cognitive function in midlife
2020
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 2604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35yrs, 54% women, and 45% black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at Y10 through Y30. At each visit, moderate/high risk of ESRD using Kidney Disease: Improving Global Outcomes (KDIGO) guidelines (estimated glomerular filtration rate 30), was defined and totaled over exams, which was categorized into no episode, 1 episode and >1 episodes of ESRD risk. At Y30, participants underwent global and multi-domain 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 one or more episodes of ESRD risk exposure. Individuals with higher 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 socio-demographic status and cardiovascular risk factors. CONCLUSIONS In the population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course is 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.
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