Relationship between longitudinal measures of renal function and onset of dementia in a community cohort of older adults.
Relationship between longitudinal measures of renal function and onset of dementia in a community cohort of older adults.
复制标题
DOI：
10.1111/j.1532-5415.2012.04238.x
复制
发表时间：
2012-12
影响因子：
6.3
通讯作者：
Larson EB
中科院分区：
文献类型：
--
作者：
O'Hare AM;Walker R;Haneuse S;Crane PK;McCormick WC;Bowen JD;Larson EB
先前的研究已经描述了在单个时间点肾功能水平较低的患者中痴呆或认知功能恶化的发生率较高。评估肾功能动态测量值随时间的变化与痴呆发作之间的关系。前瞻性社区队列研究。2，968名65岁及以上的成年人在中位数为6.0年（四分位数范围为3.1-10.1年）的时间内随访痴呆症的发展。基于总计49，340次血清肌酐测量值构建了肾功能的时变指标，包括：估计肾小球滤过率（eGFR）的平均水平、eGFR轨迹和5年暴露时间窗内eGFR在该轨迹周围的变异性。使用针对其他患者特征校正的考克斯回归模型估计这三种eGFR暴露指标与痴呆风险之间的关联。在敏感性分析中，我们还调整了尿蛋白试纸的时变测量值。eGFR水平较低的患者痴呆发生率较高，但在校正分析中未达到统计学显著性（综合p值=0.14）。随着时间的推移，eGFR轨迹阳性（综合p值=0.07）和eGFR变异性较大（综合p值=0.04）的患者中，痴呆的校正发生率有升高的趋势。敏感性分析的结果，包括我们纳入随时间变化的蛋白尿指标的结果，与主要分析的结果一致。在一个中位随访6年的老年人社区队列中，我们没有发现肾脏疾病严重程度和进展与痴呆事件之间的强相关性。
Prior studies have described a higher incidence of dementia or worsening cognitive function in patients with lower levels of kidney function at a single point in time. To evaluate the association between dynamic measures of renal function ascertained over time with onset of dementia. prospective community cohort study. 2,968 adults aged 65 and older followed for the development of dementia over a median of 6.0 years (interquartile range 3.1–10.1 years). Time varying measures of renal function were constructed based on a total of 49,340 serum creatinine measurements and included: the average level of estimated glomerular filtration rate (eGFR), eGFR trajectory and variability in eGFR around this trajectory over 5-year exposure windows. The association between these three eGFR exposure measures and risk of dementia was estimated using a Cox regression model adjusted for other patient characteristics. In sensitivity analyses, we also adjusted for time-varying measures of urine protein by dipstick. Patients with lower levels of eGFR had a higher incidence of dementia but this did not reach statistical significance in adjusted analyses (omnibus p value=0.14). There were trends toward a higher adjusted incidence of dementia in patients with positive eGFR trajectories (omnibus p value=0.07) and greater variability in eGFR (omnibus p value=0.04) over time. The results of sensitivity analyses, including those in which we included time-varying measures of proteinuria, were consistent with those of the primary analysis. Among a community cohort of older adults followed for a median of 6 years, we did not find strong associations between measures of kidney disease severity and progression and incident dementia.
登录
查看更多内容
DOI：
10.1097/01.asn.0000131529.60019.fa
发表时间：
2004-07-01
影响因子：
13.6
作者：
Seliger, SL;Siscovick, DS;Kuller, LH
通讯作者：
Kuller, LH
影响因子：
39.2
作者：
Larson, EB;Wang, L;Kukull, W
通讯作者：
Kukull, W
DOI：
10.2215/cjn.05530610
发表时间：
2011-06-01
影响因子：
9.8
作者：
Joosten, Hanneke;Izaks, Gerbrand J.;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
影响因子：
13.2
作者：
Barzilay, Joshua I.;Fitzpatrick, Annette L.;Kuller, Lewis H.
通讯作者：
Kuller, Lewis H.
影响因子：
5.3
作者：
Lin, Chien-Yu;Lin, Lian-Yu;Lin, Jou-Wei
通讯作者：
Lin, Jou-Wei