Advertisement

Kidney function and cognitive impairment among older hospitalized patients: a comparison of four glomerular filtration rate equations

  • Elisa Pierpaoli
  • Katia Fabi
  • Federica Francesca Lenci
  • Maddalena Ricci
  • Mirko Di RosaEmail author
  • Graziano Onder
  • Stefano Volpato
  • Carmelinda Ruggiero
  • Antonio Cherubini
  • Andrea Corsonello
  • Fabrizia Lattanzio
Original Article
  • 32 Downloads

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Estimated glomerular filtration rate (eGFR) Creatinine Cognitive impairment Constructional apraxia Chronic kidney disease 

Notes

Author contributions

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.

Funding

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

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40520_2019_1405_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 kb)

References

  1. 1.
    Mandelli S, Riva E, Tettamanti M et al (2015) Mortality prediction in the oldest old with five different equations to estimate glomerular filtration rate: the health and anemia population-based study. PLoS ONE 10:e0136039PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Andersen K, Nybo H, Gaist D et al (2002) Cognitive impairment and mortality among nonagenarians: the Danish 1905 cohort survey. Dement Geriatr Cogn Disord 13:156–163PubMedCrossRefGoogle Scholar
  3. 3.
    Webster AC, Nagler EV, Morton RL et al (2017) Chronic Kidney Disease. Lancet 389:1238–1252PubMedCrossRefGoogle Scholar
  4. 4.
    McQuillan R, Jassal SV (2010) Neuropsychiatric complications of chronic kidney disease. Nat Rev Nephrol. 6:471–479PubMedCrossRefGoogle Scholar
  5. 5.
    Yaffe K, Ackerson L, Kurella Tamura M et al (2010) Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc 58:338–345PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Torres RV, Elias MF, Seliger S, et al (2016) Risk for cognitive impairment across 22 measures of cognitive ability in early-stage chronic kidney disease. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal AssociationGoogle Scholar
  7. 7.
    Zammit AR, Katz MJ, Zimmerman ME et al (2015) Low eGFR is associated with dysexecutive and amnestic mild cognitive impairment. Alzheimer’s & Dementia 1:152–159Google Scholar
  8. 8.
    Joosten H, Izaks GJ, Slaets JP et al (2011) Association of cognitive function with albuminuria and eGFR in the general population. Clinical J Am Soc Nephrol 6:1400–1409CrossRefGoogle Scholar
  9. 9.
    Konig M, Gollasch M, Spira D et al (2018) Mild-to-moderate chronic kidney disease and geriatric outcomes: analysis of cross-sectional data from the Berlin aging study II. Gerontology 64:118–126PubMedCrossRefGoogle Scholar
  10. 10.
    Brodski J, Rossell SL, Castle DJ et al (2019) A systematic review of cognitive impairments associated with kidney failure in adults before natural age-related changes. J Int Neuropsychol Soc 25:101–114PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Zammit AR, Katz MJ, Bitzer M et al (2016) Cognitive impairment and dementia in older adults with chronic kidney disease: a review. Alzheimer Dis Assoc Disord 30:357–366PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Fan L, Levey AS, Gudnason V et al (2015) Comparing GFR estimating equations using cystatin C and creatinine in elderly individuals. J Am Soc Nephrol 26:1982–1989PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Romijn MD, van Marum RJ, Emmelot-Vonk MH et al (2015) Mild chronic kidney disease is associated with cognitive function in patients presenting at a memory clinic. Int J Geriatr Psychiatry 30:758–765PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Schaeffner ES, Ebert N, Delanaye P et al (2012) Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 157:471–481PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Koppe L, Klich A, Dubourg L et al (2013) Performance of creatinine-based equations compared in older patients. J Nephrol 26:716–723PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Levey AS, Becker C, Inker LA (2015) Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA 313:837–846PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Pottel H, Hoste L, Dubourg L et al (2016) An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant 31:798–806PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Tosato M, Settanni S, Antocicco M et al (2013) Pattern of medication use among older inpatients in seven hospitals in Italy: results from the CRiteria to assess Appropriate Medication use among Elderly complex patients (CRIME) project. Current drug Saf 8:98–103CrossRefGoogle Scholar
  22. 22.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198Google Scholar
  23. 23.
    Lesher EL, Berryhill JS (1994) Validation of the geriatric depression scale-short form among inpatients. J Clin Psychol 50:256–260PubMedCrossRefGoogle Scholar
  24. 24.
    Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Hales E, Yudofsky JA (eds) (2003) The American psychiatric press textbook of psychiatry. American Psychiatric Publishing Inc, WashingtonGoogle Scholar
  26. 26.
    Blanc B, Finch CA, Hallberg L et al (1968) Nutritional anaemias report of a WHO Scientific Group. WHO Tech Rep Ser 405:1–40Google Scholar
  27. 27.
    Kertesz A, Harlock W, Coates R (1979) Computer tomographic localization, lesion size, and prognosis in aphasia and nonverbal impairment. Brain Lang 8:34–50PubMedCrossRefGoogle Scholar
  28. 28.
    Song SH, Kim IJ, Kim SJ et al (2008) Cerebral glucose metabolism abnormalities in patients with major depressive symptoms in pre-dialytic chronic kidney disease: statistical parametric mapping analysis of F-18-FDG PET, a preliminary study. Psychiatry Clin Neurosci 62:554–561PubMedCrossRefGoogle Scholar
  29. 29.
    Claus JJ, Walstra GJ, Bossuyt PM et al (1999) A simple test of copying ability and sex define survival in patients with early Alzheimer’s disease. Psychol Med 29:485–489PubMedCrossRefGoogle Scholar
  30. 30.
    Lavery LL, Starenchak SM, Flynn WB et al (2005) The clock drawing test is an independent predictor of incident use of 24-hour care in a retirement community. J Gerontol A Biol Sci Med Sci 60:928–932PubMedCrossRefGoogle Scholar
  31. 31.
    Antonelli-Incalzi R, Corsonello A, Pedone C et al (2006) Drawing impairment predicts mortality in severe COPD. Chest 130:1687–1694PubMedCrossRefGoogle Scholar
  32. 32.
    Royall DR (2006) Double jeopardy. Chest 130:1636–1638PubMedCrossRefGoogle Scholar
  33. 33.
    Antonelli Incalzi R, Corsonello A, Trojano L et al (2009) Heart rate variability and drawing impairment in hypoxemic COPD. Brain Cogn 70:163–170PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Kurella M, Chertow GM, Luan J et al (2004) Cognitive impairment in chronic kidney disease. J Am Geriatr Soc 52:1863–1869PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Kurella Tamura M, Wadley V, Yaffe K et al (2008) Kidney function and cognitive impairment in US adults: the reasons for geographic and racial differences in stroke (REGARDS) Study. Am J Kidney Dis 52:227–234PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Kurella Tamura M, Xie D, Yaffe K et al (2011) Vascular risk factors and cognitive impairment in chronic kidney disease: the chronic renal insufficiency cohort (CRIC) study. Clin J Am Soc Nephrol 6:248–256PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Andro M, Le Squere P, Estivin S et al (2013) Anaemia and cognitive performances in the elderly: a systematic review. Eur J Neurol 20:1234–1240PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Wei Y, Wei YK, Zhu J (2017) Early markers of kidney dysfunction and cognitive impairment among older adults. J Neurol Sci 375:209–214PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Martens RJ, Kooman JP, Stehouwer CD et al (2017) Estimated GFR, albuminuria, and cognitive performance: the Maastricht study. Am J Kidney Dis 69:179–191PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Torres RV, Elias MF, Seliger S et al (2017) Risk for cognitive impairment across 22 measures of cognitive ability in early-stage chronic kidney disease. Nephrol Dial Transpl 32:299–306CrossRefGoogle Scholar
  41. 41.
    Yaffe K, Kurella-Tamura M, Ackerson L et al (2014) Higher levels of cystatin C are associated with worse cognitive function in older adults with chronic kidney disease: the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc 62:1623–1629PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Spencer RJ, Wendell CR, Giggey PP et al (2013) Psychometric limitations of the mini-mental state examination among nondemented older adults: an evaluation of neurocognitive and magnetic resonance imaging correlates. Exp Aging Res 39:382–397PubMedCrossRefGoogle Scholar
  43. 43.
    Wellens NI, Flamaing J, Tournoy J et al (2013) Convergent validity of the cognitive performance scale of the interRAI acute care and the mini-mental state examination. Am J Geriatr Psychiatry. 21:636–645PubMedCrossRefGoogle Scholar
  44. 44.
    Travers C, Byrne GJ, Pachana NA et al (2013) Validation of the interRAI cognitive performance scale against independent clinical diagnosis and the Mini-Mental State Examination in older hospitalized patients. J Nutr Health Aging. 17:435–439PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elisa Pierpaoli
    • 1
  • Katia Fabi
    • 2
  • Federica Francesca Lenci
    • 3
  • Maddalena Ricci
    • 3
  • Mirko Di Rosa
    • 4
    Email author
  • Graziano Onder
    • 5
  • Stefano Volpato
    • 6
  • Carmelinda Ruggiero
    • 7
  • Antonio Cherubini
    • 8
  • Andrea Corsonello
    • 4
  • Fabrizia Lattanzio
    • 9
  1. 1.Advanced Technology Center for Aging Research, Scientific Technological AreaIRCCS INRCAAnconaItaly
  2. 2.Unit of NeurologyIRCCS INRCAAnconaItaly
  3. 3.Unit of NephrologyIRCCS INRCAAnconaItaly
  4. 4.Unit of Geriatric Pharmacoepidemiology and BiostatisticsIRCCS INRCA, Ancona and CosenzaAnconaItaly
  5. 5.Department of Cardiovascular and endocrine-metabolic diseases, and agingIstituto Superiore di SanitàRomeItaly
  6. 6.Department of Medical Sciences, Section of Internal and Cardiorespiratory MedicineUniversity of FerraraFerraraItaly
  7. 7.Section of Gerontology and Geriatrics, Department of MedicineUniversity of PerugiaPerugiaItaly
  8. 8.Geriatria, Accettazione geriatrica e Centro di Ricerca per l’InvecchiamentoIRCCS INRCAAnconaItaly
  9. 9.Scientific DirectionIRCCS INRCAAnconaItaly

Personalised recommendations