Association of phenylacetylglutamine and cognitive impairment in chronic kidney disease
Résumé
Background Chronic kidney disease (CKD) leads to the accumulation of uremic toxins (UTs). Studies have suggested that UTs are associated with cognitive impairment (CI) in CKD patients. Recently studies reported that phenylacetylglutamine (PAG) contributes to the association between CKD and CI. However, this association has not been investigated in adult non-dialysis-dependent with CKD. Methods The CKD-REIN cohort study included 3033 patients with CKD stages 2-5. This cross-sectional analysis included those with a PAG measurement and a Mini-Mental State Examination (MMSE) score within 3 months of each other. CI was defined as an MMSE score ≤26/30. Logistic regression were used to assess the association between PAG and CI. Results Of the 2590 patients included (mean (standard deviation (SD)) age: 67 (13); mean (SD) estimated glomerular filtration rate (eGFR): 34 (13) mL/min/1.73m2; median [interquartile range] PAG level: 2.1 [1.2-3.6] mg/L), 908 (35%) presented an MMSE score ≤26/30. After adjustment for sociodemographic factors (age, sex, educational level), cardiovascular risk factors, cerebrovascular disease, current depression, eGFR, urinary albumin to creatinine ratio and UTs known to be associated with CI risk, a two-fold increase in the PAG level was associated with CI (odds ratio [95% confidence interval]: 1.13 [1.01, 1.28]). Conclusions This study shows that a higher serum PAG level was associated with CI in adult non-dialysis-dependent with CKD and highlight a new UT associated with CI in patients with CKD. Further studies are needed to confirm the causal nature of the association and to explore strategies for reducing serum PAG levels to protect cognition.
