Abstract
Introduction:
The prevalence of chronic kidney disease (CKD) is increasing, with a
potential impact in the risk of acceleration of dementia. The potential
association between glomerular filtration rate (eGFR) and cognitive
performance was scarcely studied. The aim of this study was to evaluate
cognitive performance levels across different degrees of kidney
function.
Methods:
We analyzed 240 outpatients in a nephrology service, classified according to
eGFR: Advanced (≤ 30ml/min/1.73m2), Moderate
(30,1ml/min/1.73m2 to ≤ 60ml/min/1.73m2),
and Mild CKD (> 60ml/min/1.73m2). Word list memory, Semantic
fluency, Mental State Mini Exam and Trail Making Test (TMT) were applied to
evaluate cognitive performance. In the TMT, lower scores are associated with
better cognition. In linear regression, cognitive function was considered as
dependent variables while groups based on eGFR were considered explanatory
variables. The group with eGFR > 60ml/min was the reference and models
were adjusted for confounding factors.
Results:
In our population (n = 240) 64 patients (26.7%) were classified as having
advanced, 98(40,8%) moderate, and 78(32,5%) mild. There was no statistical
difference among them in MMSE or in the verbal fluency test. However,
comparing to mild, patients with advanced CKD presented significantly worse
cognitive performance measured by TMTA [50,8s ± 31.1s versus 66,6s
± 35,7s (p = 0.016)] and TMTB [92,7s ± 46,2s
versus 162,4s ± 35,7s (p < 0.001)]. Significantly
lower TMTB scores (CI95%) 33,0s (4,5-61,6s) were observed in patients with
mild compared to advanced CKD in the multivariate analysis adjusting for
age, education, sex, diabetes, and alcohol use.
Conclusion:
Advanced CKD is independently associated with poorer cognitive performance
measured by an executive performance test compared to mild CKD.
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