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

• DOI: 10.1111/jgs.12986
• Publication Date: 2014-08-14T14:06:56Z
• Authors: Kristine Yaffe; Manjula Kurella‐T...; Lynn Ackerson; Tina D. Hoang; Amanda H. Anderson; Mark Duckworth; Alan S. Go; Marie Krousel‐Wood; John W. Kusek; James P. Lash; Akinlolu Ojo; Nancy Robinson; Ashwini R. Sehgal; James H. Sondheimer; Susan Steigerwalt; Raymond R. Townsend
• Keywords: cognition; Male; Aging; Kidney Disease; Biomedical and clinical sciences; Renal and urogenital; 610; Neuropsychological Tests; Basic Behavioral and Social Science; Medical and Health Sciences; 7. Clean energy; 03 medical and health sciences; Cognition; 0302 clinical medicine; Clinical Research; Health Services and Systems; cystatin C; Chronic Kidney Disease; Health Sciences; Behavioral and Social Science; Psychology; Humans; Renal Insufficiency; Prospective Studies; Chronic; Cystatin C; Renal Insufficiency, Chronic; Aged; Biomedical and Clinical Sciences; Neurosciences; Health sciences; Middle Aged; United States; 3. Good health; Geriatrics; 13. Climate action; CRIC Study Investigators; Multivariate Analysis; Female; Cognition Disorders; chronic kidney disease; Biomarkers

ObjectivesTo determine the association between cognition and levels of cystatin C in persons with chronic kidney disease (CKD).DesignProspective observational study.SettingChronic Renal Insufficiency Cohort Cognitive Study.ParticipantsIndividuals with a baseline cognitive assessment completed at the same visit as serum cystatin C measurement (N = 821; mean age 64.9, 50.6% male, 48.6% white).MeasurementsLevels of serum cystatin C were categorized into tertiles; cognitive function was assessed using six neuropsychological tests. Scores on these tests were compared across tertiles of cystatin C using linear regression and logistic regression to examine the association between cystatin C level and cognitive performance (1 standard deviation difference from the mean).ResultsAfter multivariable adjustment for age, race, education, and medical comorbidities in linear models, higher levels of cystatin C were associated with worse cognition on the modified Mini‐Mental State Examination, Buschke Delayed Recall, Trail‐Making Test Part (Trails) A and Part B, and Boston Naming (P < .05 for all). This association remained statistically significant for Buschke Delayed Recall (P = .01) and Trails A (P = .03) after additional adjustment for estimated glomerular filtration rate (eGFR). The highest tertile of cystatin C was associated with greater likelihood of poor performance on Trails A (odds ratio (OR) = 2.17, 95% confidence interval (CI) = 1.16–4.06), Trails B (OR = 1.89, 95% CI = 1.09–3.27), and Boston Naming (OR = 1.85, 95% CI = 1.07–3.19) than the lowest tertile after multivariate adjustment in logistic models.ConclusionIn individuals with CKD, higher serum cystatin C levels were associated with worse cognition and greater likelihood of poor cognitive performance on attention, executive function, and naming. Cystatin C is a marker of cognitive impairment and may be associated with cognition independent of eGFR.