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Updated: May 26, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Kidney Function and Incident Stroke and Dementia Using an Updated Estimated Glomerular Filtration Rate Equation
Samuel R Moen1, Jeffrey R Misialek1, Timothy M Hughes2,3
1Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
Rationale & Objective:
Equations for estimated glomerular filtration rate (eGFR) have previously included a coefficient for African American race. We evaluated and compared risk of incident stroke and dementia between old and new equations of eGFR for African American and non-African American participants.
Study Design:
Prospective observational study.
Setting & Participants:
Baseline values were collected from 6,814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort between 2000 and 2002. Participants were followed up until 2018. The analytic sample consisted of 6,646 participants (mean [SD] age 62 [10] years; 53% female; 39% White, 27% African American, 12% Chinese American, and 22% Hispanic/Latino).
Exposure:
eGFR equation from 2021 based on serum creatinine and cystatin C levels without race.
Outcome:
Incident stroke and dementia.
Analytical Approach:
Cox proportional regression adjusting for demographic, lifestyle, and clinical variables was performed to estimate associations between different eGFR measures and risk of incident stroke and dementia.
Results:
During a median follow-up period of 17 years, 349 (5.3%) participants experienced an incident stroke event, and 574 (8.6%) participants experienced incident dementia. In the fully adjusted model, overall participants with eGFR <60 compared with those >90 mL/min/1.73 m2 were at significantly increased risk of dementia (HR, 95% CI: 1.73, 1.21-2.45). A lower eGFR was not significantly associated with incident stroke (1.30, 0.75-2.24). African American participants tended to be reclassified to a lower group of eGFR in the new equations, whereas non-African American participants were reclassified to a higher group of eGFR. When comparing older versus newer equations of eGFR in African American and non-African American participants in association with incident stroke and dementia, differences were minimal.
Limitations:
Incident dementia was ascertained through International Classification of Diseases (Ninth and Tenth Revisions) codes.
Conclusions:
Our findings illustrate participants with 2021 eGFR < 60 compared with those with eGFR > 90 mL/min/1.73 m2 have higher risk of dementia in both African American and non-African American participants, but not of stroke.
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