Reader Response: Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults

This registry-based analysis reports a strong correlation between renal function, estimated from a creatinine-based formula, and dementia.1 However, the pathologic mechanism underlying this observation remains unclear. Because direct effects of creatinine on cognitive function are highly unlikely, further discussion is needed to determine whether causes or consequences of declining renal function are responsible for this association. In the case of reduced estimated glomerular filtration rate (eGFR) after living kidney donation from otherwise healthy individuals, such a differentiation is urgently needed. In later stages of chronic kidney disease, accumulation of unspecified uremic toxins may be 1 potential explanation—however, such a mechanism must be questioned at eGFR between 60 and 89 mL/minute present in a large proportion of healthy individuals.

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