Higher Levels of Cystatin C Are Associated with Worse Cognitive Function in Older Adults with Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort Cognitive Study1. Issue 9 (14th August 2014)

• Record Type: Journal Article
• Authors: Yaffe, Kristine; Kurella‐Tamura, Manjula; Ackerson, Lynn; Hoang, Tina D.; Anderson, Amanda H.; Duckworth, Mark; Go, Alan S.; Krousel‐Wood, Marie; Kusek, John W.; Lash, James P.; Ojo, Akinlolu; Robinson, Nancy; Sehgal, Ashwini R.; Sondheimer, James H.; Steigerwalt, Susan; Townsend, Raymond R.; the CRIC Study Investigators
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 9(2014:Sep.)
• Page Start: 1623
• Page End: 1629
• Publication Date: 2014-08-14
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12986
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12986-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12986-sec-0001" sec-type="section"> <title>Objectives</title> <p>To determine the association between cognition and levels of cystatin C in persons with chronic kidney disease (CKD).</p> </sec> <sec id="jgs12986-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective observational study.</p> </sec> <sec id="jgs12986-sec-0003" sec-type="section"> <title>Setting</title> <p>Chronic Renal Insufficiency Cohort Cognitive Study.</p> </sec> <sec id="jgs12986-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals with a baseline cognitive assessment completed at the same visit as serum cystatin C measurement (N = 821; mean age 64.9, 50.6% male, 48.6% white).</p> </sec> <sec id="jgs12986-sec-0005" sec-type="section"> <title>Measurements</title> <p>Levels of serum cystatin C were categorized into tertiles; cognitive function was assessed using six neuropsychological tests. Scores on these tests were compared across tertiles of cystatin C using linear regression and logistic regression to examine the association between cystatin C level and cognitive performance (1 standard deviation difference from the mean).</p> </sec> <sec id="jgs12986-sec-0006" sec-type="section"> <title>Results</title> <p>After multivariable adjustment for age, race, education, and medical comorbidities in linear models, higher levels of cystatin C were associated with worse cognition on the modified Mini‐Mental State Examination, Buschke Delayed Recall, Trail‐Making Test Part (Trails) A and Part B, and Boston Naming (<italic>P</italic> < .05 for all). This association remained statistically significant for Buschke Delayed Recall (<italic>P</italic> = .01) and Trails A (<italic>P</italic> = .03) after additional adjustment for estimated glomerular filtration rate (eGFR). The highest tertile of cystatin C was associated with greater likelihood of poor performance on Trails A (odds ratio (OR) = 2.17, 95% confidence interval (CI) = 1.16–4.06), Trails B (OR = 1.89, 95% CI = 1.09–3.27), and Boston Naming (OR = 1.85, 95% CI = 1.07–3.19) than the lowest tertile after multivariate adjustment in logistic models.</p> </sec> <sec id="jgs12986-sec-0007" sec-type="section"> <title>Conclusion</title> <p>In individuals with CKD, higher serum cystatin C levels were associated with worse cognition and greater likelihood of poor cognitive performance on attention, executive function, and naming. Cystatin C is a marker of cognitive impairment and may be associated with cognition independent of eGFR.</p> </sec> </abstract>