Interactive effect of obesity and cognitive function decline on the risk of chronic kidney disease progression in patients with type 2 diabetes mellitus: a 9.1-year cohort study

Abstract

Background: Obesity and cognitive function decline are independent risk factors for chronic kidney disease (CKD). However, few studies have examined the combined effects of obesity status and cognitive function on change in CKD risk. We aimed to evaluate the association between obesity status, cognitive function and CKD risk change in patients with type 2 diabetes mellitus (T2DM). Methods: Data on 3399 T2DM patients were extracted from a diabetes disease management program between 2006 and 2018. Univariate and multivariate analyses were used to assess the association between obesity, cognitive decline, and CKD risk change. Three indexes, including the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI), were used to analyze interactions. CKD risk was classified according to the KDIGO 2012 CKD definition. Results: In multivariate analysis, the hazard ratio (HR, 95%Cis) for CKD risk progression was 1.34 (1.12-1.61) times higher in the moderate and severely obese patients compared with the normal weight patients, and 1.34 (1.06-1.67) times higher in the patients with a Mini-Mental State Examination (MMSE) score ≤18 compared to those with an MMSE score ≥24. There was a synergistic interaction between moderate and severe obesity and MMSE score ≤18 on CKD risk progression (SI=4.461; 95% CI: 1.998-9.962), and the proportion of CKD risk progression caused by this interaction was 52.7% (API=0.527; 95% CI: 0.295-0.759). However, normal weight and MMSE score ≥24 were not beneficial on CKD risk improvement in the patients with a moderate risk and very high-risk stage of CKD. Conclusion: There may be a synergistic interaction between obesity and cognitive function decline, and the synergistic interaction may increase the risk of CKD progression.

Connections between Cognitive Impairment and Atrial Fibrillation in Patients with Diabetes Mellitus Type 2

“…Other studies analyzed the relationship between CD, DM-2, and CKD. Thus, a study carried out on 3399 patients with DM-2 showed that obesity and CD are independent risk factors for the progression of CKD, especially in women [ 62 ]. Otherwise, another study determined that patients with DM-2 and CKD, especially those with advanced kidney damage, may have cognitive disorders [ 63 ].…”

Gut microbiota mediating the effect of chronic kidney disease on cognitive dysfunction: a mendelian randomization study

“…Domestic and international studies on the relationship between cognitive dysfunction and CKD are currently in the exploratory stage, and there is still debate about the causal relationship between CKD and cognitive dysfunction. Some studies indicate that CKD may cause cognitive dysfunction [9][10][11] , while others imply that cognitive dysfunction may be caused by other factors such as age, education level, vascular disease [12] , hypertension [13] , and diabetes mellitus [14,15] . However, previous studies have revealed limitations, including insu cient statistical robustness and some shortcomings in making causal inferences due to small population sizes, different interpretations of the ndings, and the presence of confounders such as socio-cultural demographic characteristics and pre-existing cerebrovascular events.…”