PWV is an independent determinant of cognitive dysfunction in CKD patients

Objectives: In the general population aortic stiffening assessed by carotid femoral pulse wave velocity (cf-PWV) is associated with cognitive dysfunction (CO/DY). Data in chronic kidney disease (CKD) are limited. Our study tests the hypothesis that large artery stiffness and microvascular damage in CKD patients are related to brain microcirculation changes reflected by impaired cognitive function. Methods: Among 244 patients, finally 44 with CKD stage 1; 47 stage 2; 25 stage 3; 35 stage 4, with mean age 58.4 years (64.5% males), were enrolled in a cross-sectional study. Cognitive impairment measured by Mini Mental State Examination (MMSE), Clock – drawing test (Clock-test), and Instrumental Activity of Daily Living (IADL) was considered as primary outcome. We directly measured brachial, aortic, systolic blood pressure, pulse pressure, mean blood pressure and cf-PWV. Results: Our patients revealed a significant linear deterioration in all the domains of cognitive function according to CKD stages, assessed by MMSE, Clock-test and IADL. The risk of cognitive dysfunction increased significantly from CKD stage 3 to 4 (p<0.01). High levels of cf-PWV (p=0.029) and aortic pulse pressure (aPP) (p<0.026), were independent predictors of cognitive decline according to MMSE. Conclusions: The present trial supports the interaction between the kidney and the brain injury microcirculation. In clinical practice cf-PWV and aPP measurements may help to predict cognitive decline. Whether, the reduction in aortic stiffness following an aggressive treatment translates into improved cognitive outcomes remains to be determined.