Sex Differences in Probable Dementia and Mild Cognitive Impairment in CKD and Non-CKD: The SPRINT MIND Randomized Clinical Trial

Background: Females have higher risk of cognitive decline as compared to males in the general population. However, little is known whether this sex-specific risk pattern of cognitive decline translates to individuals with chronic kidney disease (CKD). This study examined sex differences in the risk of cognitive decline in older adults with elevated blood pressure and at high risk of cardiovascular events, who participated in the Systolic Blood Pressure Intervention Trial Memory and Cognition IN Decreased Hypertension (SPRINT MIND) study, both with and without CKD. Methods: A Cox proportional hazard model was used to compare sex differences in the risk of incident cognitive outcomes (probable dementia [PD], mild cognitive impairment [MCI]; and their composite) in males and females matched for propensity scores (based on age, race, education, randomization arm, smoking status, cardiovascular disease history systolic blood pressure, body-mass index, and estimated glomerular filtration rate [eGFR]), separately for those without and with CKD (defined as eGFR 20-59 ml/min/1.73m2). Results: Adults without CKD (n=2,506; 50% F; mean±SD age 68±9 y; eGFR 81±16 ml/min/1.73m2) and with CKD (n=1,362; 50% F; 70±9 y; eGFR 49±10 ml/min/1.73m2) were included in the study. The median (IQR) follow-up was 4.6 years (3.6-5.9) and 4.1 years (3.3-5.9) for the non-CKD and CKD groups, respectively. In adults without CKD, there were no sex differences in the risk of MCI/PD composite or PD. Males without CKD had higher MCI risk than females (Figure A). Males with CKD had higher risk of MCI/PD composite and PD than females (Figure B). Additionally, MCI risk in males with CKD tended to be higher than females. Conclusion: Males with CKD had a higher risk of PD than females; this sex difference in the risk of dementia was not observed in participants without CKD. Funding: Private Foundation SupportFigure. Sex differences in the risk of PD/MCI composite, PD, and MCI in adults without CKD (A) and with CKD (B).