Cognitive Function and Kidney Disease

Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)

Daniel E. Weiner, Sarah A. Gaussoin, John Nord, Alexander P. Auchus, Gordon J. Chelune, Michel Chonchol, Laura Coker, William E. Haley, Anthony A. Killeen, Paul L. Kimmel, Alan J. Lerner, Suzanne Oparil, Mohammad G. Saklayen, Yelena M. Slinin, Clinton B Wright, Jeff D. Williamson, Manjula Kurella Tamura

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Study Design: Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Predictors: Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Outcomes: Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Results: Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8±20.9mL/min/1.73m2 and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Limitations: Cross-sectional only, no patients with diabetes were included. Conclusions: In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting that vascular disease may mediate these relationships.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Aug 1 2016

Fingerprint

Kidney Diseases
Cognition
Blood Pressure
Albumins
Creatinine
Glomerular Filtration Rate
Cardiovascular Diseases
Urine
Chronic Renal Insufficiency
Independent Living
Leukoencephalopathies
Cerebrovascular Disorders
Albuminuria
Executive Function
Brain
Vascular Diseases
Neuroimaging
Randomized Controlled Trials
Cross-Sectional Studies
Stroke

Keywords

  • Albuminuria
  • Brain
  • Brain imaging
  • Cardiovascular disease (CVD)
  • Cerebrovascular disease
  • Cognition
  • Dementia
  • Estimated glomerular filtration rate (eGFR)
  • Executive function
  • Global cognitive function
  • Kidney disease
  • Kidney function
  • Memory
  • Neurocognitive test battery
  • Urinary albumin-creatinine ratio (UACR)
  • White matter volume

ASJC Scopus subject areas

  • Nephrology

Cite this

Weiner, D. E., Gaussoin, S. A., Nord, J., Auchus, A. P., Chelune, G. J., Chonchol, M., ... Kurella Tamura, M. (Accepted/In press). Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT). American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2017.04.021

Cognitive Function and Kidney Disease : Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT). / Weiner, Daniel E.; Gaussoin, Sarah A.; Nord, John; Auchus, Alexander P.; Chelune, Gordon J.; Chonchol, Michel; Coker, Laura; Haley, William E.; Killeen, Anthony A.; Kimmel, Paul L.; Lerner, Alan J.; Oparil, Suzanne; Saklayen, Mohammad G.; Slinin, Yelena M.; Wright, Clinton B; Williamson, Jeff D.; Kurella Tamura, Manjula.

In: American Journal of Kidney Diseases, 01.08.2016.

Research output: Contribution to journalArticle

Weiner, DE, Gaussoin, SA, Nord, J, Auchus, AP, Chelune, GJ, Chonchol, M, Coker, L, Haley, WE, Killeen, AA, Kimmel, PL, Lerner, AJ, Oparil, S, Saklayen, MG, Slinin, YM, Wright, CB, Williamson, JD & Kurella Tamura, M 2016, 'Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)', American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2017.04.021
Weiner, Daniel E. ; Gaussoin, Sarah A. ; Nord, John ; Auchus, Alexander P. ; Chelune, Gordon J. ; Chonchol, Michel ; Coker, Laura ; Haley, William E. ; Killeen, Anthony A. ; Kimmel, Paul L. ; Lerner, Alan J. ; Oparil, Suzanne ; Saklayen, Mohammad G. ; Slinin, Yelena M. ; Wright, Clinton B ; Williamson, Jeff D. ; Kurella Tamura, Manjula. / Cognitive Function and Kidney Disease : Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT). In: American Journal of Kidney Diseases. 2016.
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T2 - Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)

AU - Weiner, Daniel E.

AU - Gaussoin, Sarah A.

AU - Nord, John

AU - Auchus, Alexander P.

AU - Chelune, Gordon J.

AU - Chonchol, Michel

AU - Coker, Laura

AU - Haley, William E.

AU - Killeen, Anthony A.

AU - Kimmel, Paul L.

AU - Lerner, Alan J.

AU - Oparil, Suzanne

AU - Saklayen, Mohammad G.

AU - Slinin, Yelena M.

AU - Wright, Clinton B

AU - Williamson, Jeff D.

AU - Kurella Tamura, Manjula

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background: Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Study Design: Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Predictors: Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Outcomes: Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Results: Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8±20.9mL/min/1.73m2 and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Limitations: Cross-sectional only, no patients with diabetes were included. Conclusions: In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting that vascular disease may mediate these relationships.

AB - Background: Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. Study Design: Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND). Predictors: Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Outcomes: Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using z scores, and abnormal white matter volume quantified by brain magnetic resonance imaging. Results: Of 9,361 SPRINT participants, 2,800 participated in SPRINT-MIND and 2,707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8±20.9mL/min/1.73m2 and median urine ACR was 9.7 (IQR, 5.7-22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory, and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7, 10, 6, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR, but not eGFR, was associated with larger abnormal white matter volume. Limitations: Cross-sectional only, no patients with diabetes were included. Conclusions: In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting that vascular disease may mediate these relationships.

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KW - Cardiovascular disease (CVD)

KW - Cerebrovascular disease

KW - Cognition

KW - Dementia

KW - Estimated glomerular filtration rate (eGFR)

KW - Executive function

KW - Global cognitive function

KW - Kidney disease

KW - Kidney function

KW - Memory

KW - Neurocognitive test battery

KW - Urinary albumin-creatinine ratio (UACR)

KW - White matter volume

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