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Repeatedly Measured Serum Creatinine and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns
Juuso O Hakala1, Katja Pahkala1, Markus Juonala1
1From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku; Centre for Population Health Research (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku and Turku University Hospital; Paavo Nurmi Centre (J.O.H., K.P.), Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku; Department of Medicine (M.J., J.S.A.V.), University of Turku; Division of Medicine (M.J., J.S.A.V.), Turku University Hospital; Departments of Clinical Physiology (M.K.) and Pediatrics (N.H.-K.), Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University; Department of Clinical Chemistry (T.L.), Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University; Department of Clinical Physiology (T.P.L.), University of Eastern Finland and Kuopio University Hospital; Department of Paediatric Cardiology (E.J.), Hospital for Children and Adolescents, University of Helsinki; Department of Pediatrics (L.T.), Tampere University Hospital; Department of Pediatrics (L.T., P.T.), PEDEGO Research Unit and Medical Research Center, University of Oulu, and Oulu University Hospital; and Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Finland.
Background And Objectives:
Serum creatinine is typically used to assess kidney function. Impaired kidney function and thus high serum creatinine increase the risk of poor cognitive performance. However, serum creatinine might have a nonlinear association because low serum creatinine has been linked to cardiovascular risk and impaired cognitive performance. We studied the longitudinal association between serum creatinine and cognitive performance in midlife.
Methods:
Since 2001, participants from the Cardiovascular Risk in Young Finns Study were followed up for 10 years. Serum creatinine was measured repeatedly in 2001, 2007, and 2011. Sex-specific longitudinal trajectories for serum creatinine among participants without kidney disease were identified with latent class growth mixture modeling. Overall cognitive function and 4 specific domains-working memory, episodic memory and associative learning, reaction time, and information processing-were assessed with a computerized cognitive test.
Results:
Four serum creatinine trajectory groups with clinically normal serum creatinine were identified for both men (n = 973) and women (n = 1,204). After 10 years of follow-up, cognitive testing was performed for 2,026 participants 34 to 49 years of age (mean age 41.8 years). In men and women, consistently low serum creatinine was associated with poor childhood school performance, low adulthood education, low adulthood annual income, low physical activity, and smoking. Compared to the men in the low serum creatinine trajectory group, those in the high serum creatinine group had better overall cognitive performance (β = 0.353 SD, 95% CI 0.022-0.684) and working memory (β = 0.351 SD, 95% CI 0.034-0.668), while those in the moderate (β = 0.247 SD, 95% CI 0.026-0.468) or normal (β = 0.244 SD, 95% CI 0.008-0.481) serum creatinine groups had better episodic memory and associative learning. No associations were found for women.
Discussion:
Our results indicate that in men, compared to low serum creatinine levels, consistently high levels may be associated with better memory and learning function in midlife.
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