Inflammatory Markers and Risk for Cognitive Decline in Chronic Kidney Disease: The CRIC Study.

INTRODUCTION: Chronic kidney disease (CKD) is associated with an increased risk of cognitive decline, but the mechanisms remain poorly defined. We sought to determine the relation between serum inflammatory markers and risk of cognitive decline among adults with CKD. METHODS: We studied 757 adults aged ≥55 years with CKD participating in the Chronic Renal Insufficiency Cohort Cognitive study. We measured interleukin (IL)-1ß, IL-1 receptor antagonist, IL-6, tumor necrosis factor (TNF)-α, high-sensitivity C-reactive protein (hs-CRP), and fibrinogen in baseline plasma samples. We assessed cognitive function at regular intervals in 4 domains and defined incident impairment as a follow-up score more than 1 SD poorer than the group mean. RESULTS: The mean age of the sample was 64.3 ± 5.6 years, and the mean follow-up was 6.2 ± 2.5 years. At baseline, higher levels of each inflammatory marker were associated with poorer age-adjusted performance. In analyses adjusted for baseline cognition, demographics, comorbid conditions, and kidney function, participants in the highest tertile of hs-CRP, the highest tertile of fibrinogen, and the highest tertile of IL-1ß had an increased risk of impairment in attention compared to participants in the lowest tertile of each marker. Participants in the highest versus lowest tertile of TNF-α had a lower adjusted risk of impairment in executive function. There was no association between other inflammatory markers and change in cognitive function. DISCUSSION: Among adults with CKD, higher levels of hs-CRP, fibrinogen, and IL-1ß were associated with a higher risk of impairment in attention. Higher levels of TNF-α were associated with a lower risk of impaired executive function.

Loss of executive function after dialysis initiation in adults with chronic kidney disease.

The association of dialysis initiation with changes in cognitive function among patients with advanced chronic kidney disease is poorly described. To better define this, we enrolled participants with advanced chronic kidney disease from the Chronic Renal Insufficiency Cohort in a prospective study of cognitive function. Eligible participants had a glomerular filtration rate of 20 ml/min/1.73m2 or less, or dialysis initiation within the past two years. We evaluated cognitive function by a validated telephone battery at regular intervals over two years and analyzed test scores as z scores. Of 212 participants, 123 did not transition to dialysis during follow-up, 37 transitioned to dialysis after baseline, and 52 transitioned to dialysis prior to baseline. In adjusted analyses, the transition to dialysis was associated with a significant loss of executive function, but no significant changes in global cognition or memory. The estimated net difference in cognitive z scores at two years for participants who transitioned to dialysis during follow-up compared to participants who did not transition to dialysis was -0.01 (95% confidence interval -0.13, 0.11) for global cognition, -0.24 (-0.51, 0.03) for memory, and -0.33 (-0.60, -0.07) for executive function. Thus, among adults with advanced chronic kidney disease, dialysis initiation was associated with loss of executive function with no change in other aspects of cognition. Larger studies are needed to evaluate cognition during dialysis initiation.

Influenza-related hospitalization of adults associated with low census tract socioeconomic status and female sex in New Haven County, Connecticut, 2007-2011.

OBJECTIVES: To help guide universal influenza vaccination efforts in the United States, it is important to know which demographic groups are currently at highest risk of costly complications of influenza infection. Few studies have examined the relationship between hospitalization with influenza and either socioeconomic status (SES) or sex. We examined associations between census tract-level SES and sex and incidence of influenza-related hospitalizations among adults. DESIGN: Descriptive analysis of data collected by active population-based surveillance for persons >18 years old hospitalized with laboratory confirmed influenza during the 2007-2008 through 2010-2011 influenza seasons. Case residential addresses were geocoded and linked to data from the 2006-2010 American Community Survey to obtain census-tract level (neighborhood) SES measures. Census-tract level SES variables included measures of poverty, education, crowding, primary language, and median income. Four levels were created for each. SETTING: New Haven, County, Connecticut. SAMPLE: Entire New Haven County population >18 years old. MAIN OUTCOME MEASURES: Age-adjusted incidence of influenza hospitalizations and relative risk by sex and by each of five SES measures. RESULTS: Crude and age-adjusted incidence progressively increased with decreasing neighborhood SES for each measure both overall and for each influenza season. Female incidence was higher than male for each age group, and female age-adjusted incidence was higher for each SES level and influenza season. CONCLUSIONS: Female sex and lower neighborhood SES were independently and consistently associated with higher incidence of hospitalization of adults with influenza. If this is more broadly the case, these findings have implications for future influenza vaccination efforts. Analysis using census tract SES measures can provide additional perspective on health disparities.

Comparison of moderate and severe hospitalized Pediatric 2009 H1N1 influenza cases.

Since its discovery in 2009, H1N1 influenza (H1N1) has spread globally. Predictive factors for severe disease in children are not well defined. Our retrospective data collection and logistic regression analysis on 137 patients hospitalized between April 2009 and February 2010 at Children's Hospital and Research Center Oakland describe clinical and epidemiologic features of H1N1 in children and determines predictors of severe disease.