Estimated GFR, Albuminuria, and Cognitive Performance: The Maastricht Study

Martens, Remy J H; Kooman, Jeroen P.; Stehouwer, Coen D. A.; Dagnelie, Pieter C.; Kallen, Carla; Koster, Annemarie; Kroon, Abraham A.; Leunissen, Karel M.L.; Nijpels, Giel; Sande, Frank M. van der; Schaper, Nicolaas C.; Sep, Simone J. S.; Boxtel, M.P.J. van; Schram, Miranda T.; Henry, Ronald M.A.

doi:10.1053/j.ajkd.2016.04.017

Cited by 64 publications

(66 citation statements)

References 48 publications

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“…We are the first to show that hyperglycemia largely explains diabetes-associated worse cognitive performance, which is in line with the results of a recent study (35) that demonstrated that SAF partially mediates the association of type 2 diabetes with reduced gray matter volume. From a pathophysiological point of view, intracellular hyperglycemia induces mitochondrial overproduction of superoxide (36), which, in turn, activates multiple pathways through which hyperglycemia could exert toxic effects on the brain either directly, by triggering neuronal dysfunction and cell death (37), or indirectly, by inducing microvascular and/or macrovascular changes (26,38,39).…”

Section: Discussionmentioning

confidence: 99%

“…Microvascular disease was defined as the presence of albuminuria and/or retinopathy. The presence of albuminuria was based on urinary albumin excretion in preferably two 24-h urine collections (26). Fundus photography of both eyes was performed using an auto fundus camera (AFC-230; Nidek, Gamagori, Japan) to assess the presence of retinopathy.…”

Section: Covariatesmentioning

confidence: 99%

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The Role of Hyperglycemia, Insulin Resistance, and Blood Pressure in Diabetes-Associated Differences in Cognitive Performance—The Maastricht Study

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Covariatesmentioning

confidence: 99%

The Role of Hyperglycemia, Insulin Resistance, and Blood Pressure in Diabetes-Associated Differences in Cognitive Performance—The Maastricht Study

et al. 2017

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“…In both the cross-sectional Maastricht Study and the longitudinal Rancho Bernardo Study, albuminuria but not GFR was associated with worse cognitive performance, with both of these population-based studies having relatively low prevalence of CKD and including participants with diabetes. 15,28 Several smaller cohorts of CKD stages 3–5 also show poorer performance on tests of executive function. 38,39 Supporting the relationship between CKD markers and worse cognitive functioning, one study of 335 elderly individuals with substantial comorbidity described an independent association of albuminuria with larger white matter disease burden and with worse cognitive performance, particularly in executive function.…”

Section: Discussionmentioning

confidence: 99%

“…10 A third more recent study evaluated data from participants in the Maastricht Study, a population-based cohort in the Netherlands with a low prevalence of CKD, and showed an association between albuminuria and lower information processing speed, particularly among older participants, but no significant association between GFR and cognitive performance. 15 All studies enrolled participants with diabetes.…”

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confidence: 99%

Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)

Weiner

Gaussoin

Nord

et al. 2017

American Journal of Kidney Diseases

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Background Chronic kidney disease (CKD) is common and associated with cardiovascular disease, cerebrovascular disease and cognitive function, although the nature of this relationship remains uncertain. Study Design Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT) Setting and Participants Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, CKD or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND) Predictors Urine albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) Outcomes Cognitive function, a priori defined as 5 cognitive domains based on 11 cognitive tests using zscores, and abnormal white matter volume quantified by brain magnetic resonance imaging Results Among 9361 SPRINT participants, 2800 participated in SPRINT-MIND and 2707 had complete data; 637 had brain imaging. Mean age was 68 years, 37% were women, 30% were black, and 20% had known cardiovascular disease. Mean eGFR was 70.8 ± 20.9 ml/min/1.73 m2 and median urine ACR was 9.7 (IQR, 5.7–22.5) mg/g. In adjusted analyses, higher ACR was associated with worse global cognitive function, executive function, memory and attention, such that each doubling of urine ACR had the same association with cognitive performance as being 7 months, 10 months, 6 months, and 14 months older, respectively. Lower eGFR was independently associated with worse global cognitive function and memory. In adjusted models, higher ACR but not eGFR was associated with larger abnormal white matter volume. Limitations Cross-sectional only, no patients with diabetes were included. Conclusions In older adults, higher urine ACR and lower eGFR have independent associations with global cognitive performance with different affected domains. Albuminuria concurrently identifies a higher burden of abnormal brain white matter disease, suggesting vascular disease may mediate these relationships.

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“…We assessed glucose metabolism status, eGFR, smoking behavior, total-to-HDL cholesterol ratio, triglyceride levels, lipid-modifying medication, office or 24 h average ambulatory systolic blood pressure, antihypertensive medication, waist-to-hip ratio, alcohol consumption and educational level as described previously 26, 35, 36 .…”

Section: Methodsmentioning

confidence: 99%

Troponin I and T in relation to cardiac injury detected with electrocardiography in a population-based cohort - The Maastricht Study

Kimenai

Martens

Kooman

et al. 2017

Sci Rep

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Interest in high-sensitivity cardiac troponin I(hs-cTnI) and T(hs-cTnT) has expanded from acute cardiac care to cardiovascular disease(CVD) risk stratification. Whether hs-cTnI and hs-cTnT are interchangeable in the ambulant setting is largely unexplored. Cardiac injury is a mechanism that may underlie the associations between troponin levels and mortality in the general population. In the population-based Maastricht Study, we assessed the correlation and concordance between hs-cTnI and hs-cTnT. Multiple regression analyses were conducted to assess the association of hs-cTnI and hs-cTnT with electrocardiographic (ECG) changes indicative of cardiac abnormalities. In 3016 eligible individuals(mean age,60 ± 8years;50.6%,men) we found a modest correlation between hs-cTnI and hs-cTnT(r = 0.585). After multiple adjustment, the association with ECG changes indicative of cardiac abnormalities was similar for both hs-cTn assays(OR,hs-cTnI:1.72,95%CI:1.40-2.10;OR,hs-cTnT:1.60,95%CI:1.22–2.11). The concordance of dichotomized hs-cTnI and hs-cTnT was κ = 0.397(≥sex-specific 75th percentile). Isolated high levels of hs-cTnI were associated with ECG changes indicative of cardiac abnormalities(OR:1.93,95%CI:1.01–3.68), whereas isolated high levels of hs-cTnT were not(OR:1.07,95%CI:0.49–2.31). In conclusion, there is a moderate correlation and limited concordance between hs-cTnI and hs-cTnT under non-acute conditions. These data suggest that associations of hs-cTnI and hs-cTnT with cardiac injury detected by ECG are driven by different mechanisms. This information may benefit future development of CVD risk stratification algorithms.

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Estimated GFR, Albuminuria, and Cognitive Performance: The Maastricht Study

Abstract: In the entire study population, albuminuria was independently associated with lower information processing speed, whereas eGFR was not associated with cognitive performance. However, both were more strongly and extensively associated with cognitive performance in older individuals.

Cited by 64 publications

References 48 publications

The Role of Hyperglycemia, Insulin Resistance, and Blood Pressure in Diabetes-Associated Differences in Cognitive Performance—The Maastricht Study

The Role of Hyperglycemia, Insulin Resistance, and Blood Pressure in Diabetes-Associated Differences in Cognitive Performance—The Maastricht Study

Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)

Troponin I and T in relation to cardiac injury detected with electrocardiography in a population-based cohort - The Maastricht Study

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