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

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2014 Aug 16

PMID 25125225

Citations 24

Authors

Kristine Yaffe

Manjula Kurella-Tamura

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

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine the association between cognition and levels of cystatin C in persons with chronic kidney disease (CKD).

Design: Prospective observational study.

Setting: Chronic Renal Insufficiency Cohort Cognitive Study.

Participants: Individuals 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).

Measurements: Levels 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).

Results: After 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.

Conclusion: In 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.

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