First stages chronic kidney disease have mild effects on cognitive performance. Results of a 15,105 brazilian adult baseline cohort

<div><p>Abstract Introduction: The aging of the population may lead to an increased prevalence of dementia and chronic kidney disease (CKD) and their overlap. Objective: We investigated the association between CKD and cognitive performance among Brazilian adults (35-74 years). Methods: Baseline data analysis of the Longitudinal Study of Adults (ELSA-Brasil), a multicenter cohort comprising 15,105 civil servants, was performed. Kidney function was defined by the CKD-Epi-estimated GRF and albumin creatinin ratio (ACR). Cognitive performance was measured across tests that included the word memory tests, verbal fluency tests and Trail Making Test B. Multiple logistic and linear regressions were used to investigate the association between CKD and global as well as test-specific lowered cognitive performance. Results: More than 90% of participants did not present CKD even considering reduced GFR or increased ACR simultaneously. Lowered cognitive performance was detected among 15.8% of the participants and mean values of GFR were slightly higher among those with normal than with lowered cognitive performance (86 ± 15 mL/min/1.73 m2 x 85 ± 16 mL/min/1.73 m2, p < 0.01). Age, education, skin-color, smoking, drinking, hypertension, and diabetes were associated with lowered cognition. After adjustment for these variables, there was no association between CKD and lowered cognitive performance. Negligibly small beta values were observed when analyzing CKD and the scores of all tests. Conclusion: These results suggest that cognitive performance remains preserved until renal function reaches significant worsening. Preventive measures to maintain renal function may contribute to the preservation of cognitive function.</p></div

Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study

<div><p>High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14–1.28), and among Asian (PR = 1.21; 95% CI: 1.12–1.32) and ‘Whites (PR = 1.19; 95% CI: 1.12–1.26) compared to Blacks. Socioeconomic and racial inequality—as measured by different indicators—are strongly associated with HBP control, beyond the expected influence of health services access.</p></div

Use of anti-hypertensive drugs.

<p>No information: n = 6.</p><p>Total users of anti-hypertensives: 4147.</p><p>Others(<1%):Aliskiren, Bisoprolol, Bumetanide, Clopamide, Benazepril, Delapril, Hydralazine, Nebivolol, Sotalol, Verapamil, Manidipine, Diltiazem, Felodipine, Fosinopril, Ibesartan, Isradipine, Lacidipine, Lercanidipine, Doxazosin, Methyldopa, Moxonidine, Nadolol, Nitrendipine, Perindopril, Pindolol, Piretanide, Reserpine, Rilmenidine, Triamterene.</p><p>Longitudinal Study of Adult Health (ELSA-Brasil), 2008–2010.</p

Use of anti-hypertensive drugs by drug classes and combinations.

<p>Longitudinal Study of Adult Health (ELSA-Brasil), 2008–2010.</p

Study population (n and %) and prevalence of high blood pressure by gender, age, socioeconomic position and race.

<p>No information: Income (n = 70); Race (n = 184) (excluded from the total).</p><p>Longitudinal Study of Adult Health (ELSA-Brasil), 2008–2010.</p

Prevalence of high blood pressure, awareness, use of anti-hypertensive drugs and blood pressure control, by gender and age, 2008–2010.

<p>Longitudinal Study of Adult Health (ELSA-Brasil), 2008–2010.</p

L'Auto-vélo : automobilisme, cyclisme, athlétisme, yachting, aérostation, escrime, hippisme / dir. Henri Desgranges

23 juillet 19321932/07/23 (A33,N11543)