Biomarkers of Renal Function and Cognitive Impairment in Patients With Diabetes
- Anne M. Murray, MD, MS1⇓,
- Joshua I. Barzilay, MD2,
- James F. Lovato, MS3,
- Jeff D. Williamson, MD, MPH4,
- Michael E. Miller, PHD3,
- Santica Marcovina, PHD, SCD5,
- Lenore J. Launer, PHD6 and
- for the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) Substudy Investigators*
- 1Department of Medicine, Geriatrics Division, Hennepin County Medical Center, and Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- 2Kaiser Permanente of Georgia and Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia
- 3Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- 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
- 5Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, Washington
- 6Laboratory of Epidemiology, Demography, Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
- Corresponding author: Anne M. Murray, .
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.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-0186/-/DC1.
- Received January 28, 2011.
- Accepted April 24, 2011.
- © 2011 by the American Diabetes Association.
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