Association of Kidney Function with Risk of Incident Dementia: A Prospective Cohort Study of 275,167 UK Biobank Participants

Abstract

Background:

Previous studies have reported inconsistent associations between chronic kidney disease (CKD) and dementia.

Objective:

To evaluate whether CKD is a risk factor for dementia and compare the performance of different measures of calculating estimated glomerular filtration rate (eGFR).

Methods:

275,167 participants from UK Biobank were included and eGFR at baseline was calculated using serum creatinine (eGFRcr), cystatin C (eGFRcys), and creatinine-cystatin C equations (eGFRcr-cys). Restricted cubic splines and Cox regression models were performed to assess the relationship of eGFR with all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VaD).

Results:

We observed a U-shaped relationship between each eGFR and risk of all-cause dementia and VaD, with eGFRcys and eGFRcr-cys showing a closer linkage (p_eGFRcys <0.0001, p_{eGFRcrhboxcys}<0.0001 and p_eGFRcr = 0.0001). Lower and supranormal eGFR were related to increased risk of all-cause dementia. Compared to the reference category of 90–104 ml/min/1.73 m², adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause dementia for eGFRcr-cys 30–59, <30, and ≥105 ml/min/1.73 m² were 1.26 (95% CI [1.05–1.50], p = 0.012), 2.62 (95% CI [1.54–4.47], p < 0.001), and 1.41 (95% CI [1.17–1.70], p < 0.001). No statistically significant association was observed between eGFR with risk of AD.

Conclusion:

This prospective study identified impaired kidney function as a critical risk factor for dementia and noted the application of cystatin C strengthened the relationship between CKD and dementia, underlining the significant value of preserving kidney function to reduce the risk of dementia and considering cystatin C measurement as part of clinical practice.