Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging and Cognitive Function in African Americans With Type 2 Diabetes Mellitus

Abstract

Background Relationships between early kidney disease, neurocognitive function and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). Study Design Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR) in African Americans with T2DM. Setting a& Participants African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American–Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n=512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n=484; 104 with MRI) studies. Predictors eGFR (CKD-EPI creatinine equation), spot UACR. Measurements MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume (WMLV); cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c, low-density lipoprotein cholesterol, smoking, hypertension and cardiovascular disease were used to test for association between kidney phenotypes and the brain in each study; a meta-analysis was performed. Results Mean participant age was 60.1±7.9 (SD) years; diabetes duration, 12.1±7.7 years; hemoglobin A1c, 8.3%±1.7%; eGFR, 88.7±21.6 ml/min/1.73 m2; and UACR, 119.2±336.4 mg/g. In the fully-adjusted meta-analysis, higher GMV associated with lower UACR (p<0.05), with a trend toward association with higher eGFR. Higher WMLV was associated with higher UACR (p<0.05) and lower eGFR (p<0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (p<0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. Limitations Cross-sectional; single UACR measurement. Conclusions In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased WMLV. UACR was associated with poorer processing speed and working memory.

Progression of brain white matter hyperintensities in asymptomatic patients with carotid atherosclerotic plaques and no indication for revascularization

“…The third independent variable associated with WMH progression was GFR, with lower GFR values in WHM progressors. The finding that patients with impaired renal function have an increased WMH burden has been reported in several cross-sectional studies both in subjects with cardiovascular risk factors [35,36], and patients with previous stroke [37,38]. Nevertheless, this is the first longitudinal study in patients with a carotid plaque showing a significant association between renal impairment and risk of WMH progression.…”

Association of sickle cell trait with measures of cognitive function and dementia in African Americans

“…The prevalence of CSVD and risk factors for CSVD are significantly higher among African Americans compared to non-Hispanic Whites [2]. This disparity exists even after adjusting for traditional dementia risk factors and relevant covariates [3,4]. Several studies have reported on the contribution of genetic variation, such as the APOE ε4 genotype, to the incidence and prevalence of dementia and cognitive decline in both African Americans and non-Hispanic Whites [[5], [6], [7]].…”

“…Furthermore, studies have shown that African Americans with SCT have a significantly higher risk for atrial fibrillation and other cardiovascular phenotypes [11,12]. Both CKD [3,13,14] and atrial fibrillation [15,16] have been reported to be significantly associated with an increased risk of cognitive decline and dementia. A recent study also showed that young African Americans were significantly more likely to have evidence of silent cerebral infarcts on MRI compared to healthy age and sex matched controls.…”

White Matter Microstructure Changes and Cognitive Impairment in the Progression of Chronic Kidney Disease

“…However, so far, brain imaging studies of patients with non-end-stage kidney disease are limited. Recent structural MRI studies have found abnormal brain volumes in patients with CKD ( Murea et al, 2015 ; Freedman et al, 2017 ; Hartung et al, 2018 ), but it remains unclear whether specific brain changes associated with cognitive impairment will occur in the non-end-stage of CKD.…”