TY - JOUR
T1 - Cerebral structural changes in diabetic kidney disease
T2 - African American-diabetes heart study MIND
AU - Sink, Kaycee M.
AU - Divers, Jasmin
AU - Whitlow, Christopher T.
AU - Palmer, Nicholette D.
AU - Smith, S. Carrie
AU - Xu, Jianzhao
AU - Hugenschmidt, Christina E.
AU - Wagner, Benjamin C.
AU - Williamson, Jeff D.
AU - Bowden, Donald W.
AU - Maldjian, Joseph A
AU - Freedman, Barry I.
N1 - Publisher Copyright:
© 2015 by the American Diabetes Association.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - 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.
AB - 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.
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U2 - 10.2337/dc14-1231
DO - 10.2337/dc14-1231
M3 - Article
C2 - 25205141
AN - SCOPUS:84921904600
SN - 0149-5992
VL - 38
SP - 206
EP - 212
JO - Diabetes care
JF - Diabetes care
IS - 2
ER -