Adult Chronic Kidney Disease: Neurocognition in Chronic Renal Failure

Abstract

In recent years there has been a keen interest in the neurocognitive sequelae of renal failure and subsequent end-stage renal disease given its increasing prevalence and incidence. This review article summarizes the relevant information on cognitive functioning in chronic kidney disease in adults before the initiation of dialysis, after the initiation of dialysis, and after renal transplantation. In general, compared to pre-dialysis, there is an improvement in cognitive function after the institution of dialysis and further improvement after renal transplantation. Throughout the paper an attempt is made to highlight the importance of considering disease related variables in the neuropsychological assessment of individuals with chronic kidney disease. The paper concludes with a discussion of future avenues of research.

Executive function in end-stage renal disease: Acute effects of hemodialysis and associations with clinical factors

“…A range of disorders related to neuronal function have been observed in patients with end-stage renal disease (ESRD), including cognitive problems [1, 2]. Neuropsychological impairments including memory, learning, attention, and executive function (EF) deficits, have been described in ESRD patients on hemodialysis (ESRD-HD) [3, 4].…”

Risk Factors for Selective Cognitive Decline in Dialyzed Patients with End-Stage Renal Disease: Evidence from Verbal Fluency Analysis

“…First, many dialyzers, due to the sieving characteristics of the membrane, are still not able to remove all the toxins, middle-large molecules in particular (Ronco & La Greca, 2002), and, for unknown reasons, these toxins have been shown to particularly affect frontal white matter as well as basal ganglia (Okada, Yoshikawa, Matsuo, Kanno, & Oouchi, 1991). Additionally, despite its beneficial effects, the dialysis process itself, mostly by repeatedly inducing cerebral ischemia or cerebral edema, may result in microvascular lesions and, thus, produce new or amplify pre-existing (e.g., vascular) cognitive impairment (Koushik et al, 2010). Of note, white matter hyperintensities have been shown to preferentially impair frontal lobe function regardless of their location (Tullberg et al, 2004).…”

Cognitive Impairment in Chronic Kidney Disease-Prevalence, Mechanisms and Consequences

“…Interestingly, patients with early stages of CKD already show cognitive impairment [20]. Depending on CKD stage, CKD is frequently associated with prevalence of cognitive impairment in different domains including executive function, information processing speed, memory and language, which range from 17% to 87% [7,[9][10][11][12][13][14][15].…”

“…Regarding consequences of CKD, most studies concentrate on cardiovascular morbidity and mortality [6], while cognitive function, which is an important determinant of adherence to CKD therapy, is often overlooked [7]. Cognitive impairment in CKD is getting an increasingly relevant topic for healthcare systems, since CKD prevalence worldwide is estimated to be about 12% [8] and cognitive impairment to affect 17% to 87% of CKD patients, depending on CKD severity [7,[9][10][11][12][13][14][15].…”