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

Aging Clinical and Experimental Research volume 32, pages841–850(2020)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

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:e0136039

    PubMed  PubMed Central  Google 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 13:156–163

    PubMed  Google Scholar 

  3. 3.

    Webster AC, Nagler EV, Morton RL et al (2017) Chronic Kidney Disease. Lancet 389:1238–1252

    PubMed  Google Scholar 

  4. 4.

    McQuillan R, Jassal SV (2010) Neuropsychiatric complications of chronic kidney disease. Nat Rev Nephrol. 6:471–479

    PubMed  Google 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 58:338–345

    PubMed  PubMed Central  Google 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 Association

  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 1:152–159

    Google 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 6:1400–1409

    CAS  Google 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 64:118–126

    PubMed  Google 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 25:101–114

    PubMed  Google 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 30:357–366

    PubMed  PubMed Central  Google 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 26:1982–1989

    CAS  PubMed  Google 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 130:461–470

    CAS  PubMed  Google Scholar 

  14. 14.

    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    CAS  PubMed  Google 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 30:758–765

    PubMed  Google 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 157:471–481

    PubMed  Google Scholar 

  17. 17.

    Koppe L, Klich A, Dubourg L et al (2013) Performance of creatinine-based equations compared in older patients. J Nephrol 26:716–723

    CAS  PubMed  Google Scholar 

  18. 18.

    Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    PubMed  PubMed Central  Google 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 313:837–846

    CAS  PubMed  PubMed Central  Google 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 31:798–806

    PubMed  PubMed Central  Google 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 8:98–103

    Google 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 12:189–198

    CAS  PubMed  Google Scholar 

  23. 23.

    Lesher EL, Berryhill JS (1994) Validation of the geriatric depression scale-short form among inpatients. J Clin Psychol 50:256–260

    CAS  PubMed  Google 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 185:914–919

    CAS  PubMed  Google Scholar 

  25. 25.

    Hales E, Yudofsky JA (eds) (2003) The American psychiatric press textbook of psychiatry. American Psychiatric Publishing Inc, Washington

    Google Scholar 

  26. 26.

    Blanc B, Finch CA, Hallberg L et al (1968) Nutritional anaemias report of a WHO Scientific Group. WHO Tech Rep Ser 405:1–40

    Google Scholar 

  27. 27.

    Kertesz A, Harlock W, Coates R (1979) Computer tomographic localization, lesion size, and prognosis in aphasia and nonverbal impairment. Brain Lang 8:34–50

    CAS  PubMed  Google 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 62:554–561

    PubMed  Google 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 29:485–489

    CAS  PubMed  Google 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 60:928–932

    PubMed  Google Scholar 

  31. 31.

    Antonelli-Incalzi R, Corsonello A, Pedone C et al (2006) Drawing impairment predicts mortality in severe COPD. Chest 130:1687–1694

    PubMed  Google Scholar 

  32. 32.

    Royall DR (2006) Double jeopardy. Chest 130:1636–1638

    PubMed  Google Scholar 

  33. 33.

    Antonelli Incalzi R, Corsonello A, Trojano L et al (2009) Heart rate variability and drawing impairment in hypoxemic COPD. Brain Cogn 70:163–170

    PubMed  Google Scholar 

  34. 34.

    Kurella M, Chertow GM, Luan J et al (2004) Cognitive impairment in chronic kidney disease. J Am Geriatr Soc 52:1863–1869

    PubMed  Google 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 52:227–234

    PubMed  PubMed Central  Google 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 6:248–256

    PubMed  PubMed Central  Google 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 20:1234–1240

    CAS  PubMed  Google Scholar 

  38. 38.

    Wei Y, Wei YK, Zhu J (2017) Early markers of kidney dysfunction and cognitive impairment among older adults. J Neurol Sci 375:209–214

    CAS  PubMed  Google 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 69:179–191

    CAS  PubMed  Google 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 32:299–306

    CAS  Google 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 62:1623–1629

    PubMed  PubMed Central  Google 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 39:382–397

    PubMed  Google 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. 21:636–645

    PubMed  Google 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. 17:435–439

    CAS  PubMed  Google Scholar 

Download references

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.

Author information

Affiliations

  1. Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS INRCA, Ancona, Italy

    Elisa Pierpaoli

  2. Unit of Neurology, IRCCS INRCA, Ancona, Italy

    Katia Fabi

  3. Unit of Nephrology, IRCCS INRCA, Ancona, Italy

    Federica Francesca Lenci & Maddalena Ricci

  4. Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Via Santa Margherita 5, 60124, Ancona, Italy

    Mirko Di Rosa & Andrea Corsonello

  5. Department of Cardiovascular and endocrine-metabolic diseases, and aging, Istituto Superiore di Sanità, Rome, Italy

    Graziano Onder

  6. Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy

    Stefano Volpato

  7. Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy

    Carmelinda Ruggiero

  8. Geriatria, Accettazione geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, Ancona, Italy

    Antonio Cherubini

  9. Scientific Direction, IRCCS INRCA, Ancona, Italy

    Fabrizia Lattanzio

Authors
  1. Elisa Pierpaoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katia Fabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica Francesca Lenci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maddalena Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mirko Di Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Graziano Onder
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefano Volpato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carmelinda Ruggiero
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Cherubini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Andrea Corsonello
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Fabrizia Lattanzio
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Mirko Di Rosa.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 42 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pierpaoli, E., Fabi, K., Lenci, F.F. et al. Kidney function and cognitive impairment among older hospitalized patients: a comparison of four glomerular filtration rate equations. Aging Clin Exp Res 32, 841–850 (2020). https://doi.org/10.1007/s40520-019-01405-1

Download citation

Keywords

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