Abstract
Impaired kidney function is associated with structural brain changes and cognitive dysfunction. In the aging kidney, hemodynamic and structural alterations reduce the glomerular filtration rate (eGFR). Little is known about differences between men and women regarding decline of kidney function and brain damage.In this community-based study, we assessed associations between the eGFR, focal and diffuse brain abnormalities and cognitive functions. Sex-specific effects were analyzed by interaction terms eGFR x sex on brain structure and cognition. Interactive effects were assessed using mixed-models –stratified by sex.Overall, 196 women and 129 men (median age 68 years and mean eGFR 73.8±14.9 ml/min/1.73m2) were included. Significant associations existed between eGFR and cortical volume (β: 1.53E-04; SE: 6.72E-05; p=0.023 for neocortex). Sex exerted a significant interactive effect. Only in men, eGFR related to cortical volumes of all lobes and of deep gray matter structures (p= 0.001 for total gray matter, p=0.0004 for neocortex). In the whole group eGFR was not associated with cognition, but men with lower eGFR performed worse on tests for executive function, which, after FDR correction, was not significant.We conclude, that in community-dwelling middle-aged and elderly individuals, reduced eGFR relates to brain volume loss in men but not in women.
Highlights
Kidneys and brain are irrigated by short, small perforating arterioles, which auto-regulate perfusion pressure to maintain a continuous and stable high blood flow [1]
In the whole group eGFR was not associated with cognition, but men with lower eGFR performed worse on tests for executive function, which, after false discovery rate (FDR) correction, was not significant
After adjustment for possible confounders and correction for multiple testing, there were no significant associations between eGFR and markers of cerebral small vessel disease including volumes of white matter hyperintensities (WMH) and peak width of skeletonized mean diffusivity (PSMD)
Summary
Kidneys and brain are irrigated by short, small perforating arterioles, which auto-regulate perfusion pressure to maintain a continuous and stable high blood flow [1]. Individuals with chronic kidney disease (CKD) present a plethora of small vessel disease related brain changes [1,2,3,4] with focal and diffuse structural and microstructural abnormalities [5,6,7]. These include lacunar strokes, white matter abnormalities and microbleeds [3, 8, 9]. We first determined if eGFR in an older community-dwelling population relates to focal and diffuse structural and microstructural brain changes as well as cognitive functions, and second, if these associations, when present, are influenced by sex
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