Albuminuria, kidney function, and the incidence of cognitive impairment among adults in the United States

Manjula Kurella Tamura, Paul Muntner, Virginia Wadley, Mary Cushman, Neil A. Zakai, Brian D. Bradbury, Brett Kissela, Fred Unverzagt, George Howard, David Warnock, William McClellan

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


Background: Albuminuria and estimated glomerular filtration rate (eGFR) are each associated with increased risk of cognitive impairment, but their joint association is unknown. Study Design: Prospective cohort study. Setting & Participants: A US national sample of 19,399 adults without cognitive impairment at baseline participating in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) Study. Predictors: Albuminuria was assessed using urine albumin-creatinine ratio (UACR) and GFR was estimated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Outcomes: Incident cognitive impairment was defined as score ≤4 on the 6-Item Screener at the last follow-up visit. Results: During a mean follow-up of 3.8 ± 1.5 years, UACRs of 30-299 and <300 mg/g were associated independently with 31% and 57% higher risk of cognitive impairment, respectively, relative to individuals with UACR <10 mg/g. This finding was strongest for those with high eGFRs and attenuated at lower levels (P = 0.04 for trend). Relative to eGFR <60 mL/min/1.73 m 2, eGFR <60 mL/min/1.73 m 2 was not associated independently with cognitive impairment. However, after stratifying by UACR, eGFR <60 mL/min/1.73 m 2 was associated with a 30% higher risk of cognitive impairment in participants with UACR <10 mg/g, but not higher UACRs (P = 0.04 for trend). Limitations: Single measures of albuminuria and eGFR, screening test of cognition. Conclusions: When eGFR was preserved, albuminuria was associated independently with incident cognitive impairment. When albuminuria was <10 mg/g, low eGFR was associated independently with cognitive impairment. Albuminuria and low eGFR are complementary, but not additive, risk factors for incident cognitive impairment.

Original languageEnglish (US)
Pages (from-to)756-763
Number of pages8
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - Nov 1 2011


  • Albuminuria
  • chronic kidney disease
  • cognitive impairment

ASJC Scopus subject areas

  • Nephrology

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