Cerebral structural changes in diabetic kidney disease

African American-diabetes heart study MIND

Kaycee M. Sink, Jasmin Divers, Christopher T. Whitlow, Nicholette D. Palmer, S. Carrie Smith, Jianzhao Xu, Christina E. Hugenschmidt, Benjamin C. Wagner, Jeff D. Williamson, Donald W. Bowden, Joseph A Maldjian, Barry I. Freedman

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVE: Albuminuria and reduced kidney function are associated with cognitive impairment. Relationships between nephropathy and cerebral structural changes remain poorly defined, particularly in African Americans (AAs), a population at higher risk for both cognitive impairment and diabetes than European Americans. We examined the relationship between urine albumin:creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and cerebral MRI volumes in 263 AAs with type 2 diabetes. RESEARCH DESIGN AND METHODS: Cross-sectional associations between renal parameters and white matter (WM), gray matter (GM), hippocampal, and WM lesion (WML) volumes were assessed using generalized linearmodels adjusted for age, education, sex, BMI, hemoglobin A1c (HbA1c) level, and hypertension. RESULTS: Participants had a mean (SD) age of 60.2 years (9.7 years), and 62.7%were female. Mean diabetes duration was 14.3 years (8.9 years), HbA1c level was 8.2% (2.2%; 66 mmol/mol), eGFR was 86.0 mL/min/1.73 m2 (23.2 mL/min/1.73 m2), and UACR was 155.8 mg/g (542.1mg/g;median 8.1mg/g). Those with chronic kidney disease (CKD) (eGFR <60 mL/min/1.73 m2 or UACR >30 mg/g) had smaller GM and higher WML volumes. Higher UACR was significantly associatedwith higherWML volume and greater atrophy (larger cerebrospinal fluid volumes), and smaller GM and hippocampal WM volumes. A higher eGFR was associated with larger hippocampalWMvolumes. Consistentwith higherWML volumes, participants with CKD had significantly poorer processing speed and working memory. These findings were independent of glycemic control. CONCLUSIONS: We found albuminuria to be a better marker of cerebral structural changes than eGFR in AAs with type 2 diabetes. Relationships between albuminuria and brain pathology may contribute to poorer cognitive performance in patients with mild CKD.

Original languageEnglish (US)
Pages (from-to)206-212
Number of pages7
JournalDiabetes Care
Volume38
Issue number2
DOIs
StatePublished - Jan 1 2015

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Diabetic Nephropathies
Glomerular Filtration Rate
African Americans
Albuminuria
Chronic Renal Insufficiency
Albumins
Creatinine
Urine
Type 2 Diabetes Mellitus
Hemoglobins
Kidney
Sex Education
Short-Term Memory
Atrophy
Cerebrospinal Fluid
Research Design
Pathology
Hypertension
Brain
White Matter

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Sink, K. M., Divers, J., Whitlow, C. T., Palmer, N. D., Smith, S. C., Xu, J., ... Freedman, B. I. (2015). Cerebral structural changes in diabetic kidney disease: African American-diabetes heart study MIND. Diabetes Care, 38(2), 206-212. https://doi.org/10.2337/dc14-1231

Cerebral structural changes in diabetic kidney disease : African American-diabetes heart study MIND. / Sink, Kaycee M.; Divers, Jasmin; Whitlow, Christopher T.; Palmer, Nicholette D.; Smith, S. Carrie; Xu, Jianzhao; Hugenschmidt, Christina E.; Wagner, Benjamin C.; Williamson, Jeff D.; Bowden, Donald W.; Maldjian, Joseph A; Freedman, Barry I.

In: Diabetes Care, Vol. 38, No. 2, 01.01.2015, p. 206-212.

Research output: Contribution to journalArticle

Sink, KM, Divers, J, Whitlow, CT, Palmer, ND, Smith, SC, Xu, J, Hugenschmidt, CE, Wagner, BC, Williamson, JD, Bowden, DW, Maldjian, JA & Freedman, BI 2015, 'Cerebral structural changes in diabetic kidney disease: African American-diabetes heart study MIND', Diabetes Care, vol. 38, no. 2, pp. 206-212. https://doi.org/10.2337/dc14-1231
Sink, Kaycee M. ; Divers, Jasmin ; Whitlow, Christopher T. ; Palmer, Nicholette D. ; Smith, S. Carrie ; Xu, Jianzhao ; Hugenschmidt, Christina E. ; Wagner, Benjamin C. ; Williamson, Jeff D. ; Bowden, Donald W. ; Maldjian, Joseph A ; Freedman, Barry I. / Cerebral structural changes in diabetic kidney disease : African American-diabetes heart study MIND. In: Diabetes Care. 2015 ; Vol. 38, No. 2. pp. 206-212.
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AU - Palmer, Nicholette D.

AU - Smith, S. Carrie

AU - Xu, Jianzhao

AU - Hugenschmidt, Christina E.

AU - Wagner, Benjamin C.

AU - Williamson, Jeff D.

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