Cognitive Impairment: A Novel Risk Factor for Rapid Kidney Function Decline and Incident CKD in Middle-Aged Adults

Details

• Journal Article:
  Kidney360
• Personal Author:
  Bano, Ruqiyya ; Clouston, Sean A. P. ; Mann, Frank D. ; Khan, Babar A. ; Carr, Melissa A. ; Hedayati, S. Susan ; Luft, Benjamin J. ; Koraishy, Farrukh M.
• Description:
  Background: Emerging evidence suggests that better cognition is associated with a lower risk of CKD. However, whether early-onset cognitive impairment (CI) at baseline is linked to rapid eGFR decline or incident CKD remains unclear. Methods: We conducted a prospective cohort study of 5761 World Trade Center responders (mean age, 53.8+/-7.9 years) without CKD at baseline, followed for a mean of 4.2+/-1.9 years. CI was defined as a Montreal Cognitive Assessment (MoCA) score ≤23, with a subgroup analysis for baseline dementia (MoCA ≤18). Primary outcomes included annual eGFR change and rapid eGFR decline (<-5 ml/min per 1.73 m2 per year). The secondary outcome was incident CKD (eGFR <60 ml/min per 1.73 m2 or diagnosis code). Multivariable Cox proportional hazards models and linear regressions were used for binary and continuous outcomes, respectively. Sensitivity analyses included looking at the effect of baseline mild CI (MoCA score 19-23), propensity matching for demographics, baseline age younger than 60 years, removal of baseline post-traumatic stress disorder/depression or baseline head trauma/stroke/cardiovascular disease, and after exclusion of those who died during follow-up. Results: At baseline, 1446 (25%) individuals had CI, while 89 (2%) had dementia. The mean baseline eGFR was 91.1 ml/min per 1.73 m2, with an overall decline of -1.2 ml/min per 1.73 m2 per year. Rapid eGFR decline occurred in 550 (10%) individuals. After adjusting for age, sex, race and ethnicity, comorbidities, World Trade Center exposure, screened post-traumatic stress disorder, and baseline eGFR, CI and dementia were significantly associated with rapid eGFR decline (adjusted hazard ratio [aHR], 1.63 and 2.42, respectively; both P < 0.001) and faster annual eGFR decline. Findings were consistent across all sensitivity analyses. In addition, 248 (4%) individuals developed incident CKD. Both baseline CI (aHR, 1.72; P < 0.001) and dementia (aHR, 2.77; P = 0.010) were significantly associated with incident CKD. Conclusions: Among middle-aged individuals without CKD, early-onset CI was independently associated with rapid eGFR decline and incident CKD. These findings warrant validation in other cohorts.
• Subjects:
  Cognition Kidney Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Cognitive function; Kidney function; Kidney disorders; Cohort studies; World Trade Center; WTC; Aging
• Source:
  Kidney360 2025 Dec; 6(12):2130-2144
• ISSN:
  2641-7650
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; Indiana ; Texas ; New York City Region [OSHA] ; Chicago Region [OSHA] ; Dallas Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  15 pdf pages
• Volume:
  6
• NIOSHTIC Number:
  nn:20071501
• Contact Point Address:
  Dr. Farrukh M. Koraishy, Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, New York
• Email:
  Farrukh.Koraishy@stonybrookmedicine.edu
• Federal Fiscal Year:
  2026
• Performing Organization:
  The Research Foundation for the State University of New York
• Peer Reviewed:
  True
• Start Date:
  20220929
• End Date:
  20260928
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:8de83d147facc83290e382ed7a332ac4ad54bbe30f2b5c52e841299ff1155e0cb32d3e10447fd6f5ee55d7612a2982709c9428e2981a634e0878069d26ab3307
• Download URL:
  https://stacks.cdc.gov/view/cdc/259098/cdc_259098_DS1.pdf
• File Type:
  [PDF - 1021.63 KB ]