Development of atrial fibrillation (AF) in adult patients with chronic kidney disease (CKD) is not associated with a decline in cognitive function, a recent study suggests.
A study of 3254 adults with mild to moderate CKD participating in the Chronic Renal Insufficiency Cohort Study revealed no significant association between incident AF and change in cognitive function test score after a median follow-up of 6.8 years in a fully adjusted model, Mark D. McCauley, MD, of the University of Illinois at Chicago, and colleagues reported in Kidney International Reports.
The finding contrasts with the results of previous research suggesting a link between atrial fibrillation and risk for cognitive decline in non-CKD populations. Dr McCauley and colleagues offered potential reasons for this difference. It is possible that pathways linking AF to cognitive decline (hypoperfusion, thrombosis, and inflammation) “may already be activated in CKD, thus blunting the effect of incident AF on cognitive function.” Another possibility is that patients with incident AF may have received more intensive medical care and control of vascular risk factors for cognitive decline, the investigators stated.
“Despite our overall negative findings, AF still represents a high-risk state for patients with CKD,” the authors wrote. For example, they cited a recent large population study from Sweden showing that individuals with AF are at increased risk for stroke.
Patients in the current study had incident AF ascertained by 12-lead electrocardiogram obtained at a study visit and/or identification of a hospitalization with AF during follow-up. Their cognitive function was assessed biennially using the Modified Mini-Mental State Exam. Higher scores on this exam indicate higher cognitive function.
Of the 3254 patients in the study, 96 had incident AF and 3158 did not. Compared with the no-AF group, the patients with AF were older (mean 61.1 vs 56.9 years), had a higher prevalence of cardiovascular disease (44.8% vs 27.7%) and hypertension (92.7% vs 85.6%), and lower estimated glomerular filtration rate (38.9 vs 45.6 mL/min/1.73 m2).
McCauley MD, Hsu JY, Ricardo AC, et al. Atrial fibrillation and longitudinal change in cognitive function in CKD. Published online January 5, 2021. Kidney Int Rep. doi:10.1016/j.ekir.2020.12.023