Cognitive impairment in chronic kidney disease: clinical findings, risk factors and consequences for patient care

Abstract

Cognitive deficits have a high prevalence in elderly patients with chronic kidney disease (CKD). The clinical picture consists of cognitive slowing, executive, memory and language deficits, and is attributed to cerebral white matter disease and clinically often silent brain infarcts. In the meantime, robust evidence exists that low estimated glomerular filtration rate, a measure of CKD severity, predisposes to cognitive deficits, cerebral white matter lesions, and ischemic brain infarcts in addition to demographic factors, vascular risk factors and diseases which also contribute to CKD-related cognitive deficits. In terminal CKD, cerebral blood flow is compromized during hemodialysis sessions, resulting in oxygen desaturation, cognitive deterioration and-in the longer run-brain atrophy. Kidney transplantation improves cognitive deficits in terminal CKD. At all stages, vascular risk factors and associated diseases should stringently be treated according to therapeutic guidelines.

Klotho regulates postnatal neurogenesis and protects against age-related spatial memory loss

“…In the KL-deficient mice, terminal decline of the body could impact brain phenotypes as is observed in human disease (Hermann et al 2014; Picano et al 2014). In the KL overexpressing model, overexpression in cells that do not normally make KL could cause non-physiological effects to be measured.…”

Re-Establishing Brain Networks in Patients with ESRD after Successful Kidney Transplantation

“…In the United States, approximately 8% of the population suffers from CKD, and 571,000 patients receive treatment for ESRD (1). Cognitive impairment is prevalent in patients with ESRD, with an estimated prevalence of 30%-60% (2)(3)(4)(5). This is particularly true among those receiving hemodialysis.…”

The relevance of α-KLOTHO to the central nervous system: Some key questions

“…However, the state of the kidney may influence brain health in multiple ways. Cognitive impairment is common in patients with chronic kidney disease (CKD), and within the general population decreased kidney function is a risk factor for future cognitive decline (Hermann et al, 2014). The mechanism by which CKD causes cognitive decline appears distinct to the neurological defects seen in kl/kl mice since CKD is an established cause of decreased vitamin D levels.…”