Abstract 108: Chronic Kidney Disease Is Associated with the Risk of Dementia in Patients with Vascular Risk Factors Independently of Cerebral Small Vessel Disease
Background and Purpose: Vascular disease is an important cause of dementia and cognitive decline. In this context, chronic kidney disease (CKD) has emerged as a possible risk factor of cognitive decline. Small-vessel pathology due to endothelial dysfunction has been evoked to explain the connection between kidney and cerebral microvasculature: they share similar anatomic and physiologic characteristics. However, to what extent CKD impact future dementia beyond cerebral small vessel disease (SVD) is unknown. We assessed the predictive value of CKD, when controlling for MRI-findings on the risk of dementia.
Methods: Using data from a Japanese cohort of participants with vascular risk factors in an ongoing observational study from 2001, we evaluated the association between dementia and CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min per 1.73 m2). Baseline brain MRI was used to determine SVD (lacunar and white matter hyperintensities), medial-temporal atrophy and subcortical atrophy. Cox proportional hazards analysis was performed as predictors of dementia with adjusting for age, gender, APOE ε4 allele, educational level, baseline MMSE score, clinical stroke (previous and incident), conventional vascular risk factors, and MRI-findings.
Results: Of 600 subjects (mean: 68 ± 8.3 years, male: 57%, 12.8 ± 2.6 years of schooling, CKD: 29%, mean eGFR: 68.4 ± 17.4 mL/min per 1.73 m2), a total of 50 incident dementia cases were diagnosed (Alzheimer disease: 24 patients, vascular dementia: 18, mixed type dementia: 5, other type: 3), during median 7.5 years follow-up. Baseline eGFR and the presence of CKD were associated with an increased risk of all-cause dementia in the age, gender, education level, and APOE ε4 allele adjusted models. These associations of both eGFR (per 1-SD decrease) and CKD remained significant even after additional adjusting for MRI-findings and confounding variables (HR: 1.44, 95% CI [1.02-2.02], and HR: 2.30 [1.19-4.43], respectively).
Conclusion: Our longitudinal study showed that CKD was independently related to the risk of all-cause dementia in patients with vascular risk factors. Our results reinforce the hypothesis that CKD exert deleterious effects on dementia incidence.
Author Disclosures: K. Miwa: None. M. Tanaka: None. S. Okazaki: None. S. Furukado: None. Y. Yagita: None. M. Sakaguchi: None. H. Mochizuki: None. K. Kitagawa: None.
- © 2014 by American Heart Association, Inc.