Biomarkers of Renal Function and Cognitive Impairment in Patients With Diabetes

  1. for the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) Substudy Investigators*
  1. 1Department of Medicine, Geriatrics Division, Hennepin County Medical Center, and Minneapolis Medical Research Foundation, Minneapolis, Minnesota
  2. 2Kaiser Permanente of Georgia and Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia
  3. 3Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  4. 4Roena Kulynych Center for Memory and Cognition Research, Departments of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  5. 5Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, Washington
  6. 6Laboratory of Epidemiology, Demography, Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
  1. Corresponding author: Anne M. Murray, amurray{at}cdrg.org.

Abstract

OBJECTIVE Kidney disease is associated with cognitive impairment in studies of nondiabetic adults. We examined the cross-sectional relation between three measures of renal function and performance on four measures of cognitive function in the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) study.

RESEARCH DESIGN AND METHODS The relationships among estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (n = 2,968), albumin/creatinine ratio (ACR) ≥30 μg/mg (n = 2,957), and cystatin C level >1.0 mg/L (n = 532) with tertile of performance on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop Test of executive function were measured.

RESULTS In adjusted logistic regression models, ACR ≥30 μg/mg was associated with performance in the lowest tertile, compared with the highest two tertiles, on the RAVLT (odds ratio 1.30, 95% CI 1.09–1.56, P = 0.006), equivalent to 3.6 years of aging, and on the DSST (1.47, 1.20–1.80, P = 0.001), equivalent to 3.7 years of aging. Cystatin C >1.0 mg/L was borderline associated with the lowest tertile on the DSST (1.81, 0.93–3.55, P = 0.08) and Stroop (1.78, 0.97–3.23, P = 0.06) in adjusted models. eGFR was not associated with any measure of cognitive performance.

CONCLUSIONS In diabetic people with HbA1c >7.5% at high risk for cardiovascular disease, decreased cognitive function was associated with kidney disease as measured by ACR, a measure of microvascular endothelial pathology, and cystatin C, a marker of eGFR.

Footnotes

  • Received January 28, 2011.
  • Accepted April 24, 2011.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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  1. Diabetes Care vol. 34 no. 8 1827-1832
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