Kidney function and cognitive impairment among older hospitalized patients: a comparison of four glomerular filtration rate equations
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The relationship between the estimated glomerular filtration rate (eGFR) and cognitive impairment may change as a function of the equation used. We aimed at investigating the association between four different eGFR equations and cognitive impairment among older hospitalized patients.
Our series consisted of 795 older patients consecutively admitted to 7 geriatric and internal medicine acute care wards. The eGFR was calculated by Chronic Kidney Disease Epidemiologic Collaboration (CKD-EPI), Cockcroft-Gault (CG), Berlin Initiative Study (BIS) and Full Age Spectrum (FAS) equations. Study outcomes were total Mini Mental State Examination (MMSE) < 24 and sub-scores related to orientation to time, orientation to space, registration, calculation, three words recall, language and constructional praxis. Statistical analysis was carried out by logistic or Poisson regressions when appropriate. The accuracy of eGFR equations in identifying cognitive outcomes was investigated by calculating the area (AUC) under the receiver operating characteristic (ROC) curve for each equation.
After adjusting for potential confounders, eGFR < 30 was significantly associated with MMSE < 24 only with CKD-EPI equation (OR 2.03, 95% CI 1.04–3.96). eGFR < 30 was significantly associated with constructional apraxia with all study equations (CKD-EPI: OR 3.62, 95% CI 1.73–7.56; BIS: OR 2.86, 95% CI 1.31–6.26; FAS: OR 2.83, 95% CI 1.44–5.56; CG: OR 2.08, 95% CI 1.09–3.99). The accuracy of eGFR < 30 in identifying patients with defective constructional praxis was poor with all (BIS: AUC 0.54, 95% CI 0.52–0.55; CKD-EPI: AUC 0.55, 95% CI 0.53–0.57; CG: AUC 0.58, 95% CI 0.55–0.61; FAS: AUC 0.56, 95% CI 0.54–0.58).
Constructional apraxia may characterize the cognitive profile of older patients with severe CKD. The accuracy in identifying patients with constructional apraxia is only fair, and studies including other biomarkers of kidney function are needed.
KeywordsEstimated glomerular filtration rate (eGFR) Creatinine Cognitive impairment Constructional apraxia Chronic kidney disease
Elisa Pierpaoli, Katia Fabi, Federica Francesca Lenci and Maddalena Ricci conceived the study and participated in data analysis, manuscript writing and revising, and manuscript approval Mirko Di Rosa participated in data analysis and manuscript writing and approval. Graziano Onder, Stefano Volpato, Carmelinda Ruggiero, Antonio Cherubini and Andrea Corsonello participated in data collection and writing, revising and approving manuscript. Fabrizia Lattanzio participated in writing the manuscript, revising it for important intellectual content, and approval.
The CRIME study was partially supported by an unrestricted grant of the Italian Ministry of Health (Grant No. GR-2007-685638). Funder had no role in this paper.
Compliance with ethical standards
Conflict of interest
All Authors declare to have no competing interests with this manuscript.
Human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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