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Stroke","doi-asserted-by":"crossref","award":["RF1NS128360"],"award-info":[{"award-number":["RF1NS128360"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Urine albumin-to-creatinine ratio was associated with multiple dual trajectory groups, while eGFR was only associated with dual decline.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            Lower\n                            <jats:italic toggle=\"yes\">\u03b1<\/jats:italic>\n                            -klotho was associated with dual cognitive-physical decline versus no decline in either process.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>In healthy older adults, kidney biomarkers may potentially predict long-term cognitive and physical performance.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kidney disease contributes to both cognitive and physical decline; whether kidney health biomarkers relate to declining cognitive and physical performance separately and\/or together is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Among 1902 participants (26% Black; 53% female) in the Health, Aging, and Body Composition Study with intact baseline gait speed (\u22650.8 m\/s) and cognition (modified mini-mental state score \u226590), we assessed baseline kidney-related biomarkers (eGFR, urine albumin-to-creatinine ratio, serum 25-hydroxyvitamin D, plasma intact parathyroid hormone, plasma\n                      <jats:italic toggle=\"yes\">\u03b1<\/jats:italic>\n                      -klotho, serum intact fibroblast growth factor 23, and vitamin D metabolites) with joint trajectories of cognitive and physical performance. Grouped-based trajectory analysis of modified mini-mental state and 20-m usual gait speed up to 10 years yielded three groups: group 1 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =660), superior longitudinal cognitive-physical performance; group 2 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =744), high sustained cognition and initially lower, declining gait; and group 3 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =498), lower initial cognitive-physical performance, both steeply declining. Three sequential multinomial regression models were built with covariate adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In model 1 (kidney function), higher eGFR (per 10 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) was associated with lower odds of being in group 3 versus group 1 (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.75 to 0.94;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003) after covariate adjustment. In addition, each doubling of urine albumin-to-creatinine ratio related to higher odds of being in group 2 (OR, 1.13; 95% CI, 1.04 to 1.23;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006) and group 3 (OR, 1.23; 95% CI, 1.12 to 1.36;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) versus group 1. Log2 25-hydroxyvitamin D and log2 intact parathyroid hormone, added in model 2 (clinical biomarkers), were not significantly associated with cognitive-physical trajectory (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.63, model 2 versus model 1). However, model 3 (research biomarkers adding\n                      <jats:italic toggle=\"yes\">\u03b1<\/jats:italic>\n                      -klotho and fibroblast growth factor 23) showed higher log-2\n                      <jats:italic toggle=\"yes\">\u03b1<\/jats:italic>\n                      -klotho associated with lower odds of being in group 3 versus 1 (OR, 0.70; 95% CI, 0.52 to 0.94;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Kidney health biomarkers are potential factors in dual maintenance\/decline in cognitive-physical function. Improving kidney health may contribute to preserved function in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0000001084","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:00:29Z","timestamp":1765818029000},"page":"786-797","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Biomarkers of Kidney Health and Dual Trajectories of Cognitive and Physical Function in Older Adults"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5990-108X","authenticated-orcid":false,"given":"Aman","family":"Shrestha","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland"},{"name":"Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, 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