P0774KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE AND THE RISK OF ALL CAUSE, VASCULAR AND ALZHEIMER'S DEMENTIA: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT

Abstract

Abstract Background and Aims Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk are conflicting. In this large Swedish population-based cohort, we explore the links between kidney function, kidney function decline and dementia incidence. Method In the Stockholm CREAtinine Measurements (SCREAM) project, we studied the association of baseline eGFR with the risk of incident dementia among 329,822 residents of Stockholm who accessed healthcare, were ≥65 years and had no previous history of dementia. We estimated the rate of eGFR decline among the 205,622 residents with repeated eGFR measurements during the first year and investigated its association with dementia risk. The primary outcome was dementia incidence based on ICD-10 codes or use of anti-dementia drugs. Secondary outcomes were incidence of the dementia subtypes Alzheimer’s and vascular dementia. Results 18,983 cases of dementia (5.8% of participants) were detected throughout 1,185,304 person-years. Dementia incidence rates (IR) were progressively higher with lower eGFR: from 6.56/1000 person-years in persons with eGFR 90-104 ml/min to 30.28/1000 person-years in those with eGFR<30 ml/min). Compared with eGFR of 90-104 ml/min, lower eGFR was associated with a higher dementia risk [adjusted hazard ratio (HR), 1.69; 95% confidence interval (CI], 1.52-1.89 in eGFR 30-59 ml/min and HR 2.55, 1.86-3.50 in eGFR<30 ml/min). A steeper decline in eGFR within one year was linearly associated with higher dementia risk for declines greater than 2ml/min/1.73 m2/year. Risk magnitudes were stronger for vascular dementia than for Alzheimer. Sensitivity analyses across predefined strata or after excluding early events yielded similar results. As many as 11% (95% CI 7-14%) of dementia cases were attributed to chronic kidney disease (eGFR<60 mL/min/1.73m2), a proportion higher than that attributed to other dementia risk factors such as cardiovascular disease and diabetes. Conclusion In the general population, both low kidney function and faster kidney function decline are associated with increased risk of developing dementia, particularly vascular dementia.