High Estimated Glomerular Filtration Rate Is Associated With Worse Cognitive Performance in the Hypertensive Population: Results From the China H-Type Hypertension Registry Study

Li, Junpei; Yu, Shichao; Tan, Ziheng; Yu, Yun; Luo, Linfei; Zhou, Wei; Zhu, Linjuan; Cao, Tianyu; Tu, Jiyuan; Bao, Huihui; Huang, Xiao; Cheng, Xiaoshu

doi:10.3389/fnagi.2021.706928

Cited by 6 publications

(4 citation statements)

References 53 publications

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“…We also found that eGFR above 105 ml/min/1.73m 2 was associated with an increased risk of dementia, a finding consistent with the results from the SCREAM project [ 6 ]. Similar U-shape relationships have been observed with other health outcomes, including total mortality [ 45 ], cardiovascular mortality [ 45 ], coronary artery calcification [ 46 ], and cognitive function [ 47 ]. Upon further interrogation, we found that an eGFR ≥ 105 ml/min/1.73m 2 was associated with more than double the risk of dementia within five years of follow-up, but was not associated after ten years of follow-up.…”

Section: Discussionsupporting

confidence: 62%

Kidney function, albuminuria, and their modification by genetic factors and risk of incident dementia in UK Biobank

Yeh,

Clifton,

Collister

et al. 2023

Alz Res Therapy

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Background Associations between kidney function and dementia risk are inconclusive. Chronic kidney disease (CKD) severity is determined by levels of both estimated glomerular filtration rate (eGFR) and the urine albumin to creatinine ratio (ACR). However, whether there is a graded increase in dementia risk for worse eGFR in each ACR category is unclear. Also, whether genetic risk for dementia impacts the associations is unknown. The current study aims to investigate the associations between eGFR and albuminuria with dementia risk both individually and jointly, whether the associations vary by different follow-up periods, and whether genetic factors modified the associations. Methods In 202,702 participants aged ≥ 60 years from the UK Biobank, Cox proportional-hazards models were used to examine the associations between eGFR and urine albumin creatinine ratio (ACR) with risk of incident dementia. GFR was estimated based on serum creatinine, cystatin C, or both. The models were restricted to different follow-up periods (< 5 years, 5–10 years, and ≥ 10 years) to investigate potential reverse causation. Results Over 15 years of follow-up, 6,042 participants developed dementia. Decreased kidney function (eGFR < 60 ml/min/1.73m2) was associated with an increased risk of dementia (Hazard Ratio [HR] = 1.42, 95% Confidence Interval [CI] 1.28–1.58), compared to normal kidney function (≥ 90 ml/min/1.73m2). The strength of the association remained consistent when the models were restricted to different periods of follow-up. The HRs for incident dementia were 1.16 (95% CI 1.07–1.26) and 2.24 (95% CI 1.79–2.80) for moderate (3-30 mg/mmol) and severely increased ACR (≥ 30 mg/mmol) compared to normal ACR (< 3 mg/mmol). Dose–response associations were observed when combining eGFR and ACR, with those in the severest eGFR and ACR group having the greatest risk of dementia (HR = 4.70, 95% CI 2.34–9.43). APOE status significantly modified the association (p = 0.04), with stronger associations observed among participants with a lower genetic risk of dementia. There was no evidence of an interaction between kidney function and non-APOE polygenic risk of dementia with dementia risk (p = 0.42). Conclusions Kidney dysfunction and albuminuria were individually and jointly associated with higher dementia risk. The associations were greater amongst participants with a lower genetic risk of dementia based on APOE, but not non-APOE polygenic risk.

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Section: Discussionsupporting

confidence: 62%

Kidney function, albuminuria, and their modification by genetic factors and risk of incident dementia in UK Biobank

Yeh,

Clifton,

Collister

et al. 2023

Alz Res Therapy

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“…Conversely, in males within this eGFR range, only glycohemoglobin demonstrated a significant increase, whereas AAC, body mass index, waist circumference, arm circumference, apolipoprotein B, total cholesterol, and triglyceride showed a decreasing pattern. Accordingly, it's postulated that the increased eGFR associating with elevated AAC in females could be primarily connected to obesity, high blood lipids or diabetes, rather than the overestimation of eGFR due to malnutrition-induced muscle loss as proposed in other literature ( 21 , 23 – 25 ). The trend of increased AAC scores in females at higher eGFR impacts the nonlinear relationship between eGFR and AAC in the overall population.…”

Section: Discussionmentioning

confidence: 95%

The estimated glomerular filtration rate was U-shaped associated with abdominal aortic calcification in US adults: findings from NHANES 2013–2014

Wang,

Li,

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesThe high incidence of abdominal aortic calcification (AAC) is well-documented in individuals with severe renal function decline. However, there is limited research on the historical relationship between estimated glomerular filtration rate (eGFR) and the risk of AAC occurrence in the general population undergoing routine medical examinations. The main objective of this study was to investigate the historical relationship between eGFR and AAC in the general population of the United States.MethodsWe performed a cross-sectional study using the National Health and Nutrition Examination Survey 2013–2014 database. Weighted multivariate linear regression models were used to estimate the associations of eGFR with AAC score. Smooth curve fitting and two-piecewise linear regression were employed to explore the potential non-linear relationship.ResultsA total of 2,978 participant (48.22% were male) aged 40–80 years were included in this study. The fully-adjusted model demonstrated a negative correlation between eGFR and AAC score (β = −0.015, 95% CI: −0.023 to −0.006). However, when applying the smooth curve fitting method, a U-shaped relationship was identified, and the inflection point was calculated at 76.43 ml/min/1.73 m2 using the two-piecewise linear regression model.ConclusionsThere was a U-shaped association between eGFR and AAC score in general US adults, with an inflection point at about 76.43 ml/min/1.73 m2.

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“…Creatinine clearance, used as an index of GFR, has shown that elevated GFR may be an indicator of early target organ damage [50 ▪ ]. Studies in potential kidney donors compared mGFR by iothalamate clearance and eGFR calculated by CKD-EPI equation, while measuring kidney volume by CT, and nephron number and glomerular volume according to kidney biopsy.…”

Section: Introductionmentioning

confidence: 99%

Novel insights in classic versus relative glomerular hyperfiltration and implications on pharmacotherapy

Bielopolski

Streja

Steinmetz

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Glomerular filtration rate (GFR) assessment and its estimation (eGFR) is a long-lasting challenge in medicine and public health. Current eGFR formulae are indexed for standardized body surface area (BSA) of 1.73 m2, ignoring persons and populations wherein the ratio of BSA or metabolic rate to nephron number might be different, due to increased BSA, increased metabolic rate or reduced nephron number. These equations are based on creatinine, cystatin C or a combination of the two, which adds another confounder to eGFR assessment. Unusually high GFR values, also known as renal hyperfiltration, have not been well defined under these equations. Recent findings Special conditions such as solitary kidney in kidney donors, high dietary protein intake, obesity and diabetes are often associated with renal hyperfiltration and amenable to errors in GFR estimation. In all hyperfiltration types, there is an increased intraglomerular pressure that can be physiologic, but its persistence over time is detrimental to glomerulus leading to progressive glomerular damage and renal fibrosis. Hyperfiltration might be underdiagnosed due to BSA standardization embedded in the formula. Hence, timely intervention is delayed. Reducing intraglomerular pressure in diabetes can be achieved by SGLT2 inhibitors or low protein diet to reverse the glomerulopathy process. Summary Accurate identification of glomerular hyperfiltration as a pre-CKD condition needs accurate estimation of GFR in the above normal range should establish a threshold for timely intervention.

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High Estimated Glomerular Filtration Rate Is Associated With Worse Cognitive Performance in the Hypertensive Population: Results From the China H-Type Hypertension Registry Study

Cited by 6 publications

References 53 publications

Kidney function, albuminuria, and their modification by genetic factors and risk of incident dementia in UK Biobank

Kidney function, albuminuria, and their modification by genetic factors and risk of incident dementia in UK Biobank

The estimated glomerular filtration rate was U-shaped associated with abdominal aortic calcification in US adults: findings from NHANES 2013–2014

Novel insights in classic versus relative glomerular hyperfiltration and implications on pharmacotherapy

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