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Abstract: TH-OR25

Associations of Impaired Kidney Function With Cerebral Small Vessel Disease and Cognitive Disorders: Findings From the Framingham Heart Study

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials

Authors

  • Kelly, Dearbhla M., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Pinheiro, Adlin, Framingham Heart Study, Framingham, Massachusetts, United States
  • Anderson, Christopher D., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Aparicio, Hugo J., Framingham Heart Study, Framingham, Massachusetts, United States
  • Decarli, Charles S., University of California Davis School of Medicine, Sacramento, California, United States
  • Hwang, Shih-Jen, Framingham Heart Study, Framingham, Massachusetts, United States
  • Viswanathan, A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Romero, Jose R., Framingham Heart Study, Framingham, Massachusetts, United States
Background

CKD has been associated with cognitive dysfunction in epidemiological studies, but it is unclear if this association is independent of blood pressure (BP) and related to cerebral small vessel disease (CSVD). Using the Framingham Heart Study, a population-based longitudinal cohort study with detailed cognitive phenotyping and neuroimaging, we evaluated baseline kidney function in relation to subsequent BP measurements and CSVD, and to mild cognitive impairment (MCI) and dementia.

Methods

We included Framingham Offspring participants free of dementia, attending an examination during midlife for ascertainment of kidney function status, with brain MRI late in life, cognitive outcome data and available interim BP assessments. We related CKD (eGFR<60ml/min/1.73m2) and albuminuria (UACR≥30mg/g) to CSVD markers (enlarged perivascular spaces [ePVS] and covert brain infarcts [CBI]) using multivariate logistic regression, and to incident MCI or dementia using Cox proportional hazards regression. Models for CSVD markers adjusted for age, sex, mean premorbid systolic BP, and time interval between MRI date and exam 8. Models for incident MCI/dementia adjusted for age, sex, education, and mean premorbid systolic BP.

Results

Among 2738 participants (mean age 67.4 (SD=9.2), 187 (7%) had CKD and 251 (9%) albuminuria. Albuminuria was associated with both high burden of ePVS in mixed brain regions (adjusted OR=1.56 [1.06-2.31] p=0.026), particularly in the basal ganglia (adjusted OR=1.64 [1.13-2.38] p=0.010), and CBI (OR=1.65 [95% CI: 1.09-2.49] p=0.017). Albuminuria was also independently associated with incident MCI and dementia (adjusted HR=1.65 [1.23-2.23] p=0.001). CKD was not associated with CSVD markers but was associated with higher risk of incident dementia (adjusted HR=1.51 [1.01-2.27] p=0.046), mainly the vascular subtype (adjusted HR=2.39 [1.01-5.67] p=0.048).

Conclusion

Albuminuria was associated with both CSVD markers and cognitive disorders independent of premorbid BP, indicating that 1) hypertensive cerebral vascular injury (reflected on CSVD markers) may not be reflected by BP measurements alone, or 2) other shared pathobiology may exist between the kidney and the brain, for instance with mechanisms such as endothelial dysfunction.