2020
DOI: 10.3389/fcvm.2020.00096
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Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients

Abstract: Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Di… Show more

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Cited by 59 publications
(49 citation statements)
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“…3). Cardiovascular and cerebrovascular diseases are important factors in the etiology of cognitive impairment [9-11, 34, 39], and cerebral microbleeds, defined as small homogeneous hypointense lesions on T2-weighted gradient-echo magnetic resonance imaging, are also a risk factor for cognitive impairment [40] in patients undergoing HD. Therefore, it is important to confirm the association between cognitive function and the presence of these diseases as vascular risk factors.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…3). Cardiovascular and cerebrovascular diseases are important factors in the etiology of cognitive impairment [9-11, 34, 39], and cerebral microbleeds, defined as small homogeneous hypointense lesions on T2-weighted gradient-echo magnetic resonance imaging, are also a risk factor for cognitive impairment [40] in patients undergoing HD. Therefore, it is important to confirm the association between cognitive function and the presence of these diseases as vascular risk factors.…”
Section: Discussionmentioning
confidence: 99%
“…Although the association between cognitive impairment and HD patients is not well understood, it has been proposed that traditional risk factors include older age, presence of diabetes mellitus (DM), hypertension, and hyperlipidemia, while the nephrogenic risk factors include anemia, retention of uremic solutes, vascular calcification, longer HD durations, and vitamin D deficiency [6-8]. Furthermore, vascular risk factors, including the presence of cerebrovascular or cardiovascular disease [9-11], and factors specifically related to HD therapy, such as an increase in the ultrafiltration rate during HD [4], were reported to be associated with cognitive decline. However, to date, the factors involved in cognitive impairment in patients undergoing HD have yet to be fully identified.…”
Section: Introductionmentioning
confidence: 99%
“…However, cardiovascular and cerebrovascular diseases remain the major and severe complications in HD patients [ 1 , 2 ]. Therefore, we analyzed temporal changes in vascular function among HD patients because many investigators support the opinion that endothelial dysfunction plays a crucial role in the pathogenesis and development of atherosclerosis, and such pathological conditions are closely associated with vascular diseases [ 33 35 ].…”
Section: Discussionmentioning
confidence: 99%
“…This association appears to be robust even with advanced age: in an oldest-old cohort of community-dwelling adults aged 90+ years, our group recently reported a significant association between CKD and incident dementia as well as infratentorial cerebral microbleeds ( 4 ). Microvascular disease in CKD includes blood-brain barrier dysfunction, cerebral microbleeds, gray matter atrophy, and arteriolar neuropathology; it is driven by factors such as chronic inflammation, uremic toxins and impaired cerebral blood flow autoregulation ( 5 7 ).…”
Section: Introductionmentioning
confidence: 99%
“…While cerebral small vessel disease is a well-established phenomenon in CKD ( 7 , 13 ), the potential relationship between CKD and brain amyloid-β deposits is less clear. Of note, cystatin C has been reported to co-localize with amyloid-β, which aggregates in the hippocampus and entorhinal cortex in individuals suffering from Alzheimer's disease ( 14 ).…”
Section: Introductionmentioning
confidence: 99%