CKD, but it is less known whether cognitive decline occurs in survivors after AKI. We hypothesized that an episode of AKI is associated with poorer cognitive function, mediated, at least in part, by persistent systemic inflammation. Methods Assessment, Serial Evaluation and Subsequent Sequelae of AKI enrolled patients surviving 3 months after hospitalization with and without AKI matched on the basis of 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 Assessment, Serial Evaluation and Subsequent Sequelae of AKI, 1420 (92%) completed the 3MS assessment at 3 months and had a corresponding matched participant. Participants with AKI had lower 3MS scores at 3 years (difference −1.1 [95% confidence interval, −2.0 to −0.3] P = 0.009) compared with participants without AKI. A higher proportion of participants with AKI had a clinically meaningful (≥5 point) reduction in 3MS scores at 3 years compared with participants without AKI (14% versus 10%, P = 0.04). In mediation analyses, plasma-soluble TNF receptor-1 at 3 months after AKI mediated 35% (P = 0.02) of the AKI-related risk for 3MS scores at 3 years. Conclusions AKI was associated with lower 3MS scores, and Soluble TNF receptor 1 concentrations seemed to mediate a significant proportion of the risk of long-term cognitive impairment. Further work is needed to determine whether AKI is causal or a marker for cognitive impairment....

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


CKD，但 AKI 后幸存者是否会出现认知能力下降尚不清楚。我们假设 AKI 发作与认知功能较差有关，而认知功能至少部分是由持续性全身炎症介导的。方法 对 AKI 入院后存活 3 个月的患者进行评估、系列评估和后续后遗症，其中有和无 AKI 的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 1538 名 AKI 评估、系列评估和后续后遗症参与者中，1420 名（92%）在 3 个月时完成了 3MS 评估，并有相应的匹配参与者。与没有 AKI 的参与者相比，患有 AKI 的参与者在 3 年时的 3MS 评分较低（差异 -1.1 [95% 置信区间，-2.0 至 -0.3] P = 0.009）。与未发生 AKI 的参与者相比，患有 AKI 的参与者在 3 年时 3MS 评分出现有临床意义（≥5 分）的降低的比例较高（14% 与 10%，P = 0.04）。在中介分析中，AKI 后 3 个月时的血浆可溶性 TNF 受体 1 介导了 3 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，可溶性 TNF 受体 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......