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Nephrol Dial Transplant. 2015 Aug;30(8):1322-9. doi: 10.1093/ndt/gfv030. Epub 2015 Feb 26.

Structural and functional assessment of the brain in European Americans with mild-to-moderate kidney disease: Diabetes Heart Study-MIND.

Author information

1
Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
2
Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
3
Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
4
Internal Medicine-Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
5
Molecular Genetics and Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
6
Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
7
Radiologic Sciences and Advanced NeuroScience Imaging (ANSIR) Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA.
8
Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Abstract

BACKGROUND:

Advanced chronic kidney disease (CKD) is associated with altered cerebral structure and function. Relationships between mild-to-moderate CKD and brain morphology and cognitive performance were evaluated in European Americans (EAs).

METHODS:

A total of 478 EAs with estimated glomerular filtration rate (eGFR) >45 mL/min/1.73 m(2) and urine albumin:creatinine ratio (UACR) < 300 mg/g, most with type 2 diabetes (T2D), were included. Measures of total intracranial volume (TICV), cerebrospinal fluid volume, total white matter volume (TWMV), total gray matter volume (TGMV), total white matter lesion volume (TWMLV), hippocampal white matter volume (HWMV) and hippocampal gray matter volume (HGMV) were obtained with magnetic resonance imaging. Cognitive testing included memory (Rey Auditory Visual Learning Test), global cognition (Modified Mini-Mental State Examination) and executive function (Stroop Task, Semantic Fluency, Digit Symbol Substitution Test). Associations with CKD were assessed using log-transformed eGFR and UACR, adjusted for age, sex, body mass index, smoking, hemoglobin A1c, blood pressure, diabetes duration, cardiovascular disease and education.

RESULTS:

Participants were 55.2% female, 78.2% had T2D; mean ± SD age 67.6 ± 9.0 years, T2D duration 16.4 ± 6.5 years, eGFR 92.0 ± 22.3 mL/min/1.73 m(2) and UACR 23.8 ± 39.6 mg/g. In adjusted models, eGFR was negatively associated with TICV only in participants with T2D [parameter estimate (β): -72.2, P = 0.002]. In non-diabetic participants, inverse relationships were observed between eGFR and HGMV (β: -1.0, P = 0.03) and UACR and normalized TWMLV (β: -0.2, P = 0.03). Kidney function and albuminuria did not correlate with cognitive testing.

CONCLUSIONS:

In EAs with mild CKD enriched for T2D, brain structure and cognitive performance were generally not impacted. Longitudinal studies are necessary to determine when cerebral structural changes and cognitive dysfunction develop with progressive CKD in EAs.

KEYWORDS:

albuminuria; brain; cognitive function; kidney disease; magnetic resonance imaging

PMID:
25722384
PMCID:
PMC4513893
DOI:
10.1093/ndt/gfv030
[Indexed for MEDLINE]
Free PMC Article

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