Skip to main content
Top
Published in: BMC Nephrology 1/2016

Open Access 01-12-2016 | Research article

Anemia and risk for cognitive decline in chronic kidney disease

Authors: Manjula Kurella Tamura, Eric Vittinghoff, Jingrong Yang, Alan S. Go, Stephen L. Seliger, John W. Kusek, James Lash, Debbie L. Cohen, James Simon, Vecihi Batuman, Juan Ordonez, Gail Makos, Kristine Yaffe

Published in: BMC Nephrology | Issue 1/2016

Login to get access

Abstract

Background

Anemia is common among patients with chronic kidney disease (CKD) but its health consequences are poorly defined. The aim of this study was to determine the relationship between anemia and cognitive decline in older adults with CKD.

Methods

We studied a subgroup of 762 adults age ≥55 years with CKD participating in the Chronic Renal Insufficiency Cohort (CRIC) study. Anemia was defined according to the World Health Organization criteria (hemoglobin <13 g/dL for men and <12 g/dL for women). Cognitive function was assessed annually with a battery of six tests. We used logistic regression to determine the association between anemia and baseline cognitive impairment on each test, defined as a cognitive score more than one standard deviation from the mean, and mixed effects models to determine the relation between anemia and change in cognitive function during follow-up after adjustment for demographic and clinical characteristics.

Results

Of 762 participants with mean estimated glomerular filtration rate of 42.7 ± 16.4 ml/min/1.73 m2, 349 (46 %) had anemia. Anemia was not independently associated with baseline cognitive impairment on any test after adjustment for demographic and clinical characteristics. Over a median 2.9 (IQR 2.6–3.0) years of follow-up, there was no independent association between anemia and change in cognitive function on any of the six cognitive tests.

Conclusions

Among older adults with CKD, anemia was not independently associated with baseline cognitive function or decline.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.PubMedPubMedCentralCrossRef Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.PubMedPubMedCentralCrossRef
2.
go back to reference Murray AM, Tupper DE, Knopman DS, Gilbertson DT, Pederson SL, Li S, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216–23.PubMedCrossRef Murray AM, Tupper DE, Knopman DS, Gilbertson DT, Pederson SL, Li S, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216–23.PubMedCrossRef
3.
go back to reference Seliger SL, Siscovick DS, Stehman-Breen CO, Gillen DL, Fitzpatrick A, Bleyer A, et al. Moderate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study. J Am Soc Nephrol. 2004;15(7):1904–11.PubMedCrossRef Seliger SL, Siscovick DS, Stehman-Breen CO, Gillen DL, Fitzpatrick A, Bleyer A, et al. Moderate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study. J Am Soc Nephrol. 2004;15(7):1904–11.PubMedCrossRef
4.
go back to reference Kurella M, Chertow GM, Fried LF, Cummings SR, Harris T, Simonsick E, et al. Chronic kidney disease and cognitive impairment in the elderly: the health, aging, and body composition study. J Am Soc Nephrol. 2005;16(7):2127–33.PubMedCrossRef Kurella M, Chertow GM, Fried LF, Cummings SR, Harris T, Simonsick E, et al. Chronic kidney disease and cognitive impairment in the elderly: the health, aging, and body composition study. J Am Soc Nephrol. 2005;16(7):2127–33.PubMedCrossRef
5.
go back to reference Atti AR, Palmer K, Volpato S, Zuliani G, Winblad B, Fratiglioni L. Anaemia increases the risk of dementia in cognitively intact elderly. Neurobiol Aging. 2006;27(2):278–84.PubMedCrossRef Atti AR, Palmer K, Volpato S, Zuliani G, Winblad B, Fratiglioni L. Anaemia increases the risk of dementia in cognitively intact elderly. Neurobiol Aging. 2006;27(2):278–84.PubMedCrossRef
6.
go back to reference Shah RC, Buchman AS, Wilson RS, Leurgans SE, Bennett DA. Hemoglobin level in older persons and incident Alzheimer disease: prospective cohort analysis. Neurology. 2011;77(3):219–26.PubMedPubMedCentralCrossRef Shah RC, Buchman AS, Wilson RS, Leurgans SE, Bennett DA. Hemoglobin level in older persons and incident Alzheimer disease: prospective cohort analysis. Neurology. 2011;77(3):219–26.PubMedPubMedCentralCrossRef
7.
go back to reference Hong CH, Falvey C, Harris TB, Simonsick EM, Satterfield S, Ferrucci L, et al. Anemia and risk of dementia in older adults: findings from the Health ABC study. Neurology. 2013;81(6):528–33.PubMedPubMedCentralCrossRef Hong CH, Falvey C, Harris TB, Simonsick EM, Satterfield S, Ferrucci L, et al. Anemia and risk of dementia in older adults: findings from the Health ABC study. Neurology. 2013;81(6):528–33.PubMedPubMedCentralCrossRef
8.
go back to reference Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162(12):1401–8.PubMedCrossRef Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162(12):1401–8.PubMedCrossRef
9.
go back to reference Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13(2):504–10.PubMed Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13(2):504–10.PubMed
10.
go back to reference Leinau L, Murphy TE, Bradley E, Fried T. Relationship between conditions addressed by hemodialysis guidelines and non-ESRD-specific conditions affecting quality of life. Clin J Am Soc Nephrol. 2009;4(3):572–8.PubMedPubMedCentralCrossRef Leinau L, Murphy TE, Bradley E, Fried T. Relationship between conditions addressed by hemodialysis guidelines and non-ESRD-specific conditions affecting quality of life. Clin J Am Soc Nephrol. 2009;4(3):572–8.PubMedPubMedCentralCrossRef
11.
go back to reference Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(2):248–56.PubMedPubMedCentralCrossRef Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(2):248–56.PubMedPubMedCentralCrossRef
12.
go back to reference Feldman HI, Appel LJ, Chertow GM, Cifelli D, Cizman B, Daugirdas J, et al. The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods. J Am Soc Nephrol. 2003;14(7 Suppl 2):S148–153.PubMedCrossRef Feldman HI, Appel LJ, Chertow GM, Cifelli D, Cizman B, Daugirdas J, et al. The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods. J Am Soc Nephrol. 2003;14(7 Suppl 2):S148–153.PubMedCrossRef
13.
go back to reference Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, et al. Chronic Renal Insufficiency Cohort (CRIC) study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009;4(8):1302–11.PubMedPubMedCentralCrossRef Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, et al. Chronic Renal Insufficiency Cohort (CRIC) study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009;4(8):1302–11.PubMedPubMedCentralCrossRef
14.
go back to reference Yaffe K, Ackerson L, Kurella Tamura M, Le Blanc P, Kusek JW, Sehgal AR, et al. Chronic Renal Insufficiency Cohort I. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc. 2010;58(2):338–45.PubMedPubMedCentralCrossRef Yaffe K, Ackerson L, Kurella Tamura M, Le Blanc P, Kusek JW, Sehgal AR, et al. Chronic Renal Insufficiency Cohort I. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc. 2010;58(2):338–45.PubMedPubMedCentralCrossRef
15.
go back to reference Teng EL, Chui HC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry. 1987;48(8):314–8.PubMed Teng EL, Chui HC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry. 1987;48(8):314–8.PubMed
16.
go back to reference Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.CrossRef Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.CrossRef
17.
go back to reference Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology. 1994;44(4):609–14.PubMedCrossRef Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology. 1994;44(4):609–14.PubMedCrossRef
18.
go back to reference Buschke H, Fuld PA. Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology. 1974;24(11):1019–25.PubMedCrossRef Buschke H, Fuld PA. Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology. 1974;24(11):1019–25.PubMedCrossRef
19.
go back to reference DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world. World Health Stat Q. 1985;38(3):302–16.PubMed DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world. World Health Stat Q. 1985;38(3):302–16.PubMed
20.
go back to reference Anderson AH, Yang W, Hsu CY, Joffe MM, Leonard MB, Xie D, et al. Estimating GFR among participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2012;60(2):250–61.PubMedPubMedCentralCrossRef Anderson AH, Yang W, Hsu CY, Joffe MM, Leonard MB, Xie D, et al. Estimating GFR among participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2012;60(2):250–61.PubMedPubMedCentralCrossRef
21.
go back to reference Hayden KM, Khachaturian AS, Tschanz JT, Corcoran C, Nortond M, Breitner JC. Characteristics of a two-stage screen for incident dementia. J Clin Epidemiol. 2003;56(11):1038–45.PubMedCrossRef Hayden KM, Khachaturian AS, Tschanz JT, Corcoran C, Nortond M, Breitner JC. Characteristics of a two-stage screen for incident dementia. J Clin Epidemiol. 2003;56(11):1038–45.PubMedCrossRef
22.
go back to reference Marsh JT, Brown WS, Wolcott D, Carr CR, Harper R, Schweitzer SV, et al. rHuEPO treatment improves brain and cognitive function of anemic dialysis patients. Kidney Int. 1991;39(1):155–63.PubMedCrossRef Marsh JT, Brown WS, Wolcott D, Carr CR, Harper R, Schweitzer SV, et al. rHuEPO treatment improves brain and cognitive function of anemic dialysis patients. Kidney Int. 1991;39(1):155–63.PubMedCrossRef
23.
go back to reference Kurella Tamura M, Larive B, Unruh ML, Stokes JB, Nissenson A, Mehta RL, et al. Prevalence and correlates of cognitive impairment in hemodialysis patients: the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol. 2010;5(8):1429–38.PubMedCrossRef Kurella Tamura M, Larive B, Unruh ML, Stokes JB, Nissenson A, Mehta RL, et al. Prevalence and correlates of cognitive impairment in hemodialysis patients: the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol. 2010;5(8):1429–38.PubMedCrossRef
24.
go back to reference Kliger AS, Foley RN, Goldfarb DS, Goldstein SL, Johansen K, Singh A, et al. KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis. 2013;62(5):849–59.PubMedCrossRef Kliger AS, Foley RN, Goldfarb DS, Goldstein SL, Johansen K, Singh A, et al. KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis. 2013;62(5):849–59.PubMedCrossRef
Metadata
Title
Anemia and risk for cognitive decline in chronic kidney disease
Authors
Manjula Kurella Tamura
Eric Vittinghoff
Jingrong Yang
Alan S. Go
Stephen L. Seliger
John W. Kusek
James Lash
Debbie L. Cohen
James Simon
Vecihi Batuman
Juan Ordonez
Gail Makos
Kristine Yaffe
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2016
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-016-0226-6

Other articles of this Issue 1/2016

BMC Nephrology 1/2016 Go to the issue