Severe Decline of Estimated Glomerular Filtration Rate Associates with Progressive Cognitive Deterioration in the Elderly: A Community-Based Cohort Study
Severe Decline of Estimated Glomerular Filtration Rate Associates with Progressive Cognitive Deterioration in the Elderly: A Community-Based Cohort Study
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DOI：
10.1038/srep42690
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发表时间：
2017-02-17
影响因子：
4.6
通讯作者：
Tarng, Der-Cherng
中科院分区：
文献类型：
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作者：
Chen, Yi-Chi;Weng, Shuo-Chun;Tarng, Der-Cherng
认知功能障碍与衰老和慢性肾脏疾病（CKD）密切相关。然而，肾功能改变与发生认知障碍风险之间的关系尚未阐明。这项纵向队列研究旨在确定估计肾小球滤过率（eGFR）的年百分比变化对社区中老年人随后的认知退化或死亡的影响。从台北市老年人健康检查数据库中提取了33,654名具有eGFR测量的老年人。在随访期间，使用便携式简短心理状态问卷评估他们的认知进展至少两次。使用多变量Cox回归模型估计eGFR百分比变化导致认知功能恶化或全因死亡率的风险比（HR）。在中位随访5.4年期间，与eGFR稳定的参与者相比，eGFR严重下降（每年下降约20%）的参与者认知功能恶化的风险增加（HR, 1.33； 95%可信区间[CI]， 1.08-1.72）和综合结果（HR, 1.17; 95% CI, 1.03-1.35）。严重的eGFR下降可能预示着老年人认知能力下降或死亡。早期发现严重的eGFR下降是一个关键问题，需要临床重视。
Cognitive dysfunction is closely related to aging and chronic kidney disease (CKD). However, the association between renal function changes and the risk of developing cognitive impairment has not been elucidated. This longitudinal cohort study was to determine the influence of annual percentage change in estimated glomerular filtration rate (eGFR) on subsequent cognitive deterioration or death of the elderly within the community. A total of 33,654 elders with eGFR measurements were extracted from the Taipei City Elderly Health Examination Database. The Short Portable Mental Status Questionnaire was used to assess their cognitive progression at least twice during follow-up visits. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for cognitive deterioration or all-cause mortality with the percentage change in eGFR. During a median follow-up of 5.4 years, the participants with severe decline in eGFR (> 20% per year) had an increased risk of cognitive deterioration (HR, 1.33; 95% confidence interval [CI], 1.08-1.72) and the composite outcome (HR, 1.17; 95% CI, 1.03-1.35) when compared with those who had stable eGFR. Severe eGFR decline could be a possible predictor for cognitive deterioration or death among the elderly. Early detection of severe eGFR decline is a critical issue and needs clinical attentions.