The nature, consequences, and management of neurological disorders in chronic kidney disease

Abstract

Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD.

CHA2DS2-VASc scores and Intermountain Mortality Risk Scores for the joint risk stratification of dementia among patients with atrial fibrillation

“…21 Kidney dysfunction is associated with AF, AF-related comorbidities (including stroke), response to targeted therapies for AF, as well as cognitive decline and dementia. [22][23][24][25][26][27] Highlighting the vascular, kidney, and brain connection, the presence of vascular nephropathy was independently associated with a 15-fold increase in white matter changes found by cranial imaging in a study of 52 patients with chronic kidney disease. 26 As more biomarkers of vascular health are surveyed that involve multiple pathways of vessel physiology, the strength of the association with cerebral vascular injury increases.…”

Behavioral Changes During Development of Chronic Kidney Disease in Rats

“…Chronic kidney disease is frequently associated with neurological disorders affecting both peripheral and central nervous system resulting in behavioral abnormalities, including mental and cognitive dysfunctions (28)(29)(30). It has been shown that mild CKD may lead to activation of limbic system, central sympathetic, stress-and pain-related brain areas (31).…”

Hypertension and its role in COVID-19-related cerebrovascular disease

“…If left untreated, hypertensive encephalopathy can progress to cerebral hemorrhage, coma, and death. Other underlying conditions associated with elevated blood pressure such as kidney disease and diabetes are common comorbidities in severe COVID-19 cases and can also contribute to the occurrence of encephalopathy and seizures (103,104).…”