Background Cognitive dysfunction is common in haemodialysis patients but whether poor kidney function in the general population is also associated with higher risk of dementia remains unclear. Objective To examine the association of kidney function with incident dementia in community dwelling older adults. Design Whitehall II prospective study. Setting Population-based study on 6,050 adults, mean age 65.8 in 2007–2009. Methods Poor kidney function, defined as estimated Glomerular Filtration Rate (eGFR) <60 ml/min/1.73 m2 in 2007–2009, and adverse change in eGFR was defined as decrease ≥4 ml/min/1.73 m2 between 2007–2009 and 2012–2013. Incident dementia was ascertained through linkage to electronic health records, and Cox regression was used to examine associations with dementia. Results A total of 306 cases of dementia were recorded over a mean follow-up of 10 years. Baseline eGFR <60 was associated with a hazard ratio (HR) for dementia of 1.37 (95% CI 1.02, 1.85) in analysis adjusted for sociodemographic factors, hypertension, obesity, stroke, diabetes and cardiovascular disease/medication. Removing stroke cases at baseline and censoring them over the follow-up yielded an HR of 1.42 (95% CI 1.00, 2.00) for the association between CKD and dementia. Decline of eGFR ≥4 between 2007–2009 and 2012–2013 was associated with incidence of dementia over a 6.3 year mean follow-up (HR: 1.37; 95% CI 1.02, 1.85), with somewhat stronger associations when analyses were restricted to those with eGFR ≥60 in 2007–2009 (1.56; 95% CI: 1.12, 2.19). Conclusion Poor and declining kidney function in older adults is associated with a higher risk of dementia that is not attributable to stroke and persists after accounting for major cardiometabolic conditions.

中文翻译：

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肾功能与痴呆症发病率之间的关联：Whitehall II 队列研究的 10 年随访

背景 认知功能障碍在血液透析患者中​​很常见，但普通人群的肾功能不良是否也与痴呆风险较高相关尚不清楚。目的 研究社区老年人肾功能与痴呆事件的关系。设计Whitehall II 前瞻性研究。2007-2009 年，针对 6,050 名平均年龄为 65.8 岁的成年人进行了基于人群的研究。方法 肾功能不良定义为 2007-2009 年估计肾小球滤过率 (eGFR) <60 ml/min/1.73 m2，eGFR 不良变化定义为 2007-2009 年期间降低≥4 ml/min/1.73 m2 2012 年至 2013 年。通过与电子健康记录的链接确定痴呆症事件，并使用 Cox 回归来检查与痴呆症的关联。结果 在平均 10 年的随访中，总共记录了 306 例痴呆病例。在针对社会人口因素、高血压、肥胖、中风、糖尿病和心血管疾病/药物进行调整的分析中，基线eGFR＜60与痴呆风险比(HR)为1.37(95％CI 1.02，1.85)相关。剔除基线时的卒中病例并在随访期间对其进行审查，得出 CKD 与痴呆之间关联的 HR 为 1.42（95% CI 1.00，2.00）。2007-2009 年和 2012-2013 年期间 eGFR ≥4 的下降与 6.3 年平均随访期间痴呆的发生率相关（HR：1.37；95% CI 1.02，1.85），当分析仅限于那些情况时，关联性更强。 2007-2009 年 eGFR ≥60（1.56；95% CI：1.12，2.19）。结论 老年人的肾功能较差和下降与痴呆症的较高风险相关，这种痴呆症不是由中风引起的，并且在考虑到主要的心脏代谢状况后仍持续存在。