Could this disease increase the risk of dementia?

In a study of geographic and ethnic differences in stroke, each 10 ml/min/1.
73m2 reduction in eGFR <60 ml/min/1.
73m2 was associated with an 11% increase in the prevalence of cognitive impairment
.

Patients with chronic kidney disease (CKD) appear to be at increased risk of cognitive impairment, which is associated with vascular and neurodegenerative mechanisms
.

To explore the vascular hypothesis, the researchers examined the relationship between CKD and dementia before and after transient ischemic attacks (TIAs) and strokes
.

Compiled and organized by Yimaitong, please do not reprint without authorization
.

Study Description This is a prospective, population-based cohort study of TIA and stroke (Oxford Vascular Study; 2002-2012), identifying pre-event and post-event dementia through direct patient assessment and 5-year follow-up, supplemented by Review hospital primary care records
.

The association between pre-event dementia and CKD (defined as estimated glomerular filtration rate [eGFR] <60 ml/min/1.
73m2) was assessed using logistic regression, and post-event dementia and CKD were assessed using Cox and competing risk regression models The associations were adjusted for age, sex, education, stroke severity, prior stroke history, white matter disease, diabetes, and language impairment
.

Results ➤ Among 2305 TIA/stroke patients (median [IQR] age, 77 [67-84] years, 1133 [49%] men, 688 [30%] TIA), 1174 (50.
9%) had CKD
.

CKD versus pre-event (odds ratio [OR], 2.
04 [95% CI, 1.
52–2.
72]; P<0.
001) and post-event dementia (hazard ratio [HR], 2.
01 [95% CI, 1.
65–2.
44]; P<0.
001) 0.
001), but these associations weakened after adjusting for covariates (OR=0.
92 [0.
65-1.
31]; p=0.
65 and HR=1.
09 [0.
85-1.
39]; p=0.
50)
.

Results were similar when the competing risk model was used (subdistribution HR [SHR] = 1.
74 [1.
43-2.
12; p < 0.
001, decaying to 1.
01] [0.
78-1.
33]; adjusted p = 0.
92)
.

CKD was more strongly associated with late (>1 year) post-event dementia (SHR=2.
32, 1.
70-3.
17; p<0.
001), especially after TIA and minor stroke (SHR=3.
08, 2.
05-4.
64; p<0.
001) ), but the adjusted correlation was not significant (SHR=1.
53, 0.
90-2.
60; p=0.
12)
.

➤ 225/2305 (9.
8%) patients had preexisting dementia
.

Compared with patients with normal renal function, CKD was significantly associated with prior dementia in an unadjusted analysis (OR=2.
04, 95% CI=1.
52-2.
72; p<0.
001), especially in eGFR<30 ml/min/ 1.
73m2 (unadjusted OR=3.
21, 1.
96-5.
26; p<0.
001)
.

However, after adjusting for age, sex, and education, all associations attenuated and became insignificant
.

After additional adjustment for other factors associated with prior dementia, any association with CKD was further reduced (OR=0.
92, 0-65-1.
31; p=0.
65)
.

Exclusion of PICH did not affect the results
.

Stratification by event severity showed broadly similar associations
.

➤ Excluding those with pre-event dementia, during 7721 patient-years of follow-up (median/IQR = 4.
2/1.
5-5.
5), 432 patients developed post-event dementia (mean/standard age at diagnosis 82.
1/8.
7 years old)
.

Compared with patients with normal renal function, CKD patients had a significantly increased risk of post-event dementia (Log-rank p<0.
001;), which was particularly significant in patients whose index event was TIA or minor stroke
.

However, although CKD was strongly associated with 5-year follow-up of post-event dementia in an unadjusted Cox regression analysis (HR = 2.
01, 95% CI 1.
65-2.
44; p<0.
001 for all CKDs), there was a strong association between age, This association also disappeared after adjusting for gender and education
.

Results were similar in the 194 patients with recurrent stroke who excluded PICH and excluded follow-up
.

CKD was more strongly associated with late (>1 year) and early (<1 year) post-event dementia (HR=2.
63, 1.
96-3.
53, p<0.
001 vs 1.
60, 1.
23-2.
09, p=0.
001), but after adjustment The association also disappeared (HR=1.
40, 0.
98-2.
00, p=0.
06 late dementia vs 0.
90, 0.
64-1.
28, p=0.
57 early dementia)
.

Conclusions After adjusting for age, sex, education, and other factors previously shown to be associated with dementia, including stroke severity and white matter disease, CKD was not independently associated with either pre-event or post-event dementia, suggesting that kidney-specific neurological Degenerative mechanisms are unlikely to play an important role in the relationship between CKD and dementia
.

Compiled from: Kelly DM, Pendlebury ST, Rothwell PM.
Associations of Chronic Kidney Disease With Dementia Before and After Transient Ischemic Attack and Stroke: Population-Based Cohort Study.
Neurology.
2022 Jan 7:10.
doi: 10.
1212/WNL .
0000000000013205.
Epub ahead of print.
PMID: 34996878.