Chronic kidney disease (CKD) has been identified as a significant direct marker for cognitive decline, but controversy exists regarding the magnitude of the association of kidney function with cognitive decline across the different CKD stages. Therefore, the aim of this study was to investigate the association of kidney function with cognitive decline in older patients at high risk of cardiovascular disease, using data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Data of 5796 patients of PROSPER were used. Strata were made according to clinical stages of CKD based on estimated glomerular filtration rate; < 30 ml/min/1.73m2 (stage 4), 30-45 ml/min/1.73m2 (stage 3b), 45-60 ml/min/1.73m2 (stage 3a) and ≥ 60 ml/min/1.73m2 (stage 1–2). Cognitive function and functional status was assessed at six different time points and means were compared at baseline and over time, adjusted for multiple prespecified variables. Stratified analyses for history of vascular disease were executed. Mean age was 75.3 years and 48.3% participants were male. Mean follow-up was 3.2 years. For all cognitive function tests CKD stage 4 compared to the other stages had the worst outcome at baseline and a trend for faster cognitive decline over time. When comparing stage 4 versus stage 1–2 over time the estimates (95% CI) were 2.23 (0.60–3.85; p = 0.009) for the Stroop-Colour-Word test, − 0.33 (− 0.66–0.001; p = 0.051) for the Letter-Digit-Coding test, 0.08 (− 0.06–0.21; p = 0.275) for the Picture-Word-Learning test with immediate recall and − 0.07 (− 0.02–0.05; p = 0.509) for delayed recall. This association was most present in patients with a history of vascular disease. No differences were found in functional status. In older people with vascular burden, only severe kidney disease (CKD stage 4), but not mild to modest kidney disease (CKD stage 3a and b), seem to be associated with cognitive impairment at baseline and cognitive decline over time. The association of severe kidney failure with cognitive impairment and decline over time was more outspoken in patients with a history of vascular disease, possibly due to a higher probability of polyvascular damage, in both kidney and brain, in patients with proven cardiovascular disease.

中文翻译：

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患有心血管疾病风险的老年患者的肾功能与认知能力下降的关联：纵向数据分析。

慢性肾脏病（CKD）已被认为是认知能力下降的重要直接标志，但是在不同CKD阶段中，肾功能与认知能力下降的关联程度存在争议。因此，本研究的目的是使用普伐他汀在高危人群中的前瞻性研究（PROSPER）来研究老年心血管疾病高危患者的肾功能与认知能力下降之间的关系。使用了5796例PROSPER患者的数据。根据估计的肾小球滤过率根据CKD的临床分期制作分层。<30 ml / min / 1.73m2（阶段4），30-45 ml / min / 1.73m2（阶段3b），45-60 ml / min / 1.73m2（阶段3a）和≥60 ml / min / 1.73m2（阶段4）阶段1-2）。在六个不同的时间点评估认知功能和功能状态，并比较基线和随时间变化的平均值，并针对多个预先指定的变量进行调整。进行了血管病史的分层分析。平均年龄为75.3岁，男性为48.3％。平均随访时间为3。2年。对于所有认知功能测试，与其他阶段相比，CKD第4阶段在基线时的结局最差，并且随着时间的推移，认知下降的趋势更快。在一段时间内比较第4阶段与第1-2阶段时，Stroop-Colour-Word测试的估计值（95％CI）为2.23（0.60-3.85; p = 0.009），-0.33（-0.66-0.001; p = 0.051）对于Letter-Digit-Coding测试，立即回忆的图片单词学习测试为0.08（-0.06-0.21; p = 0.275），对于延迟回忆，为-0.07（-0.02-0.05; p = 0.509）。这种关联最常见于有血管疾病史的患者。功能状态无差异。在有血管负担的老年人中，只有严重的肾脏疾病（CKD第4期），而不是轻度至中度的肾脏疾病（CKD第3a和b期），似乎与基线时的认知障碍和认知能力的下降有关。有血管疾病史的患者中，严重肾衰竭与认知障碍和随时间下降的关联更为明显，这可能是由于已证实患有心血管疾病的患者在肾脏和大脑中多血管损伤的可能性更高。但并非轻度至中度的肾脏疾病（CKD 3a和b期），似乎与基线时的认知功能障碍和认知能力的下降有关。有血管疾病史的患者中，严重肾衰竭与认知障碍和随时间下降的关联更为明显，这可能是由于已证实患有心血管疾病的患者在肾脏和大脑中多血管损伤的可能性更高。但不是轻度至中度的肾脏疾病（CKD 3a和b期），似乎与基线时的认知障碍和随着时间的推移认知能力下降有关。有血管疾病史的患者中，严重肾衰竭与认知障碍和随时间下降的关联更为明显，这可能是由于已证实患有心血管疾病的患者在肾脏和大脑中多血管损伤的可能性更高。