Hypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR). We conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min. 237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable. Our study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.

中文翻译：

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患有糖尿病前期和慢性肾病的体弱高血压老年人：对器官损伤和认知能力的见解 - CARYATID 研究的初步结果

高血压和慢性肾脏病（CKD）具有相互交织的病理生理机制，对公共卫生构成重大挑战。糖尿病前期被认为是糖尿病的先兆，通常伴有高血压等心血管合并症，增加了虚弱前期和虚弱的风险。蛋白尿是高血压器官损伤的一个标志，会增加老年人衰弱前、衰弱和认知能力下降的风险。我们探讨了患有糖尿病前期和 CKD 的体弱老年人中白蛋白尿与认知障碍之间的关联，并根据估计的肾小球滤过率 (eGFR) 评估了认知水平。我们进行了一项研究，纳入了 2021 年 3 月至 2023 年 3 月在意大利阿韦利诺 ASL（意大利卫生部当地卫生单位）连续招募的体弱老年高血压患者，并在三个月后进行随访。纳入标准包括年龄超过 65 岁、既往诊断为无继发原因的高血压、糖尿病前期、虚弱状态、蒙特利尔认知评估 (MoCA) 评分 < 26 以及 eGFR > 15 ml/min 的 CKD。 237 名患者完成了这项研究。我们检查了白蛋白尿和 MoCA 评分之间的关​​联，发现存在显着的负相关（r：0.8846；p < 0.0001）。随后，我们比较了基于 eGFR 的 MoCA 评分，观察到显着差异 (p < 0.0001)。以蛋白尿作为因变量的多变量回归分析进一步支持了这些发现。我们的研究代表了在患有糖尿病前期和慢性肾病的体弱高血压老年人中建立白蛋白尿和 eGFR 与认知功能之间显着相关性的开创性努力。