Moderate Chronic Kidney Disease and Cognitive Function in Adults 20 to 59 Years of Age

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Abstract
Previous studies among elderly suggest an association between chronic kidney disease (CKD) and cognitive impairment. The purpose of this study was to determine whether moderate CKD is associated with cognitive performance among young, healthy, ethnically diverse adults. Three computerized cognitive function tests of visual-motor reaction time (Simple Reaction Time), visual attention (Symbol Digit Substitution), and learning/concentration (Serial Digit Learning) were administered to a random sample of participants, aged 20 to 59 yr, who completed initial interviews and medical examination in the Third National Health and Nutrition Examination Survey (NHANES III). Participants for this study (n = 4849) completed at least one cognitive function test. GFR was estimated using the Modification of Diet in Renal Disease (MDRD) equation. Moderate CKD was defined as estimated GFR (eGFR) 30 to 59 ml/min per 1.73 m2. Unadjusted, residual-adjusted, and multivariate-adjusted logistic regression models were used. The cohort was 49.0% male and 11.6% black, and median (interquartile range) age was 36 yr (27 to 45) and eGFR was 107.9 ml/min per 1.73 m2 (95.0 to 125.4). There were 31 (0.8%) prevalent cases of moderate CKD. Models were adjusted for residual effects of age, gender, race, diabetes, and other known potential confounders. In multivariate models, moderate CKD was not significantly associated with reaction time but was significantly associated with poorer learning/concentration (odds ratio 2.41; 95% confidence interval 1.30 to 5.63) and impairment in visual attention (odds ratio 2.74; 95% confidence interval 1.01 to 7.40). In summary, among those in a large nationally representative sample of healthy, ethnically diverse 20- to 59-yr-old adults, moderate CKD, reflected by eGFR 30 to 59 ml/min per 1.73 m2, was significantly associated with poorer performance in visual attention and learning/concentration.