Advanced CKD, Heart Failure and Risk of Dementia

By Victoria Socha - Last Updated: April 13, 2023

Researchers, led by Amara Sarwal, MD, conducted a study to determine whether chronic kidney disease (CKD) and heart failure are independent risk factors for Alzheimer disease/related dementias (ADRD) in a cohort of US veterans with type 2 diabetes. Results were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled Cardiorenal Syndrome: CKD, Heart Failure, and Risk for Dementia.

The cohort included US veterans ≥65 years of age with type 2 diabetes and two outpatient measurements of serum creatinine at least 60 days apart from January 1, 2008, to December 31, 2010. The date of the second creatinine measurement was considered the index date. The CKD Epidemiology Collaboration equation was used to define estimated glomerular filtration rate. International Classification of Diseases, Tenth Revision(ICD 9/10) codes from January 1, 2000, to the index date were used to define the presence of heart failure and other comorbidities.

Veterans with ADRD at baseline were excluded. Occurrences of ADRD subsequent to baseline were identified by ICD-9/10 codes from the index date to December 31, 2021.

The cohort included 362,598 US veterans. Of those, 14.6% had heart failure at baseline, 34.8% had stage 3 CKD, and 3.3% had stage 4/5 CKD. During the study period, there were 46,156 ADRD events (12.7%), 248,609 deaths (68.6%), and 258,530 composite ADRD/death events (71.3%).

In multivariable logistic regression model analysis adjusted for demographics, comorbidities, and medications, there was no association between CKD and increased risk of ADRD. There were associations between CKD and death and a composite of ADRD/death. There were associations between heart failure and increased risk of ADRD, death, and a composite of ADRD/death.

“Advanced CKD was not associated with ADRD, likely due to the competing risk of death,” the researchers said. “ADRD is a more advanced stage of cognitive function decline. Whether earlier stages of cognitive decline, which may affect quality of life, are more common in advanced CKD needs further study.”

Source: Sarwal A, Ye X, Boucher R, et al. Cardiorenal syndrome: CKD, heart failure and risk for dementia. Poster #190. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 5-11, 2023; Austin, Texas.

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