in part, by persistent systemic inflammation. Methods: ASSESS-AKI enrolled patients surviving three months after hospitalization with and without AKI matched based on demographics, comorbidities, and baseline kidney function. A subset underwent cognitive testing using the modified mini-mental status examination (3MS) at 3, 12, and 36 months. We examined the association of AKI with 3MS scores using mixed linear models and assessed the proportion of risk mediated by systemic inflammatory biomarkers. Results: Among 1538 participants in ASSESS-AKI, 1420 (92%) completed the 3MS assessment at 3 months and had a corresponding matched participant. Participants with AKI had lower 3MS scores at three years (difference -1.1 (95% CI: -2.0, -0.3) P=0.009) compared to participants without AKI. A higher proportion of AKI participants had a clinically meaningful (≥ 5 point) reduction in 3MS scores at three years compared to participants without AKI (14% vs. 10%, P=0.04). In mediation analyses, plasma soluble tumor necrosis factor receptor-1 (sTNFR-1) at three months after AKI mediated 35% (P=0.02) of the AKI related risk for 3MS scores at three years. Conclusions: AKI was associated with lower 3MS scores and sTNFR-1 concentrations appeared to mediate a significant proportion of the risk of long-term cognitive impairment. Further work is needed to determine if AKI is causal or a marker for cognitive impairment. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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急性肾损伤、全身炎症和长期认知功能：ASSESS-AKI

部分原因是持续的全身炎症。方法：ASSESS-AKI 纳入了住院后三个月存活的患有和不患有 AKI 的患者，这些患者根据人口统计学、合并症和基线肾功能进行匹配。一部分人在 3、12 和 36 个月时使用改良的简易精神状态检查 (3MS) 进行认知测试。我们使用混合线性模型检查了 AKI 与 3MS 评分的关联，并评估了全身炎症生物标志物介导的风险比例。结果：在 ASSESS-AKI 的 1538 名参与者中，1420 名（92%）在 3 个月时完成了 3MS 评估，并有相应的匹配参与者。与无 AKI 的参与者相比，患有 AKI 的参与者三年时 3MS 评分较低（差异 -1.1 (95% CI: -2.0, -0.3) P=0.009）。与未发生 AKI 的参与者相比，三年后 AKI 参与者的 3MS 评分出现临床意义（≥ 5 分）降低的比例较高（14% vs. 10%，P=0.04）。在中介分析中，AKI 后三个月的血浆可溶性肿瘤坏死因子受体-1 (sTNFR-1) 介导了三年时 3MS 评分的 35% (P=0.02) 的 AKI 相关风险。结论：AKI 与较低的 3MS 评分相关，并且 sTNFR-1 浓度似乎介导了很大一部分长期认知障碍风险。需要进一步的工作来确定 AKI 是否是认知障碍的因果因素或标志。版权所有 © 2024 美国肾脏病学会...