Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Silva, Pedro Henrique Imenez; Unwin, Robert J.; Hoorn, Ewout J.; Ortíz, Alberto; Trepiccione, Francesco; Nielsen, Rikke; Pešić, Vesna; Hafez, Gaye; Fouque, Denis; Massy, Ziad A.; Zeeuw, Chris I. De; Capasso, Giovambattista; Wagner, Carsten A.; Capasso, Giovambattista; Andrade, Alexandre; Bachmann, Maie; Bumblytė, Inga Arūnė; Covic, Adrian; Delgado, Pilar; Endlich, Nicole; Engvig, Andreas; Franssen, Casper F. M.; Frische, Sebastian; Gârneaţă, Liliana; Gesualdo, Loreto; Giannakou, Konstantinos; Goumenos, Dimitrios; Kartal, Ayşe Tuğba; Mani, Laila-Yasmin; Marti, Hanspeter; Mayer, Christopher C.; Rroji, Merita; Sakkas, Giorgos K.; Spasovski, Goce; Stevens, Kate I; Vazelov, Evgueniy; Viggiano, Davide; Zacharia, Lefteris C.; Ferreira, Ana Carina; Małyszko, Jolanta; Figurek, Andreja; Wanner, Christoph; Bruchfeld, Annette; Pépin, Marion; Wiȩcek, Andrzej; Nitsch, Dorothea; Fridolin, Ivo; Romeo, María José Soler; Barbieri, Michelangela; Batinic, B.; Carrasco, Laura; Carriazo, Sol; Gansevoort, Ron T.; Martino, Gianvito; Raso, Francesco Mattace; Nistor, Ionuţ; Ortíz, Alberto; Paolisso, Giuseppe; Rastenytė, Daiva; Ștefan, Gabriel; Tedeschi, Gioacchino; Bikbov, Boris; Endlich, Karl Hans; Godefroy, Olivier; Chillon, Jean‐Marc; Kossioni, Anastassia; Kurganaite, Justina; Perico, Norberto; Remuzzi, Giuseppe; Grodzicki, Tomasz; Zoccali, Carmine; Arıcı, Mustafa; Eckardt, Kai‐Uwe; Fliser, Danilo; Jiménez, Eugenio; König, Maximilian; Rychlík, Ivan; Deleidi, Michela; Reusz, George

doi:10.1093/ndt/gfab216

Cited by 18 publications

(3 citation statements)

References 95 publications

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“…Patients with acute DoC due to uremic encephalopathy should undergo either IHD or CRRT to achieve metabolic clearance and neurologic reevaluation (51, 102). Patients taking valproic acid, or those with acute hepatic failure, may manifest hyperammonemia and benefit from gastrointestinal tract catharsis (i.e., lactulose) and luminal antibacterial therapy (i.e., rifaximin) to reduce potentially culpable metabolites (103, 104).…”

Section: Methodsmentioning

confidence: 99%

State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist

Chang¹,

Provencio²,

Pascual

et al. 2023

Critical Care Medicine

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Objectives: To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist. Data Sources: Detailed search strategy using PubMed and OVID Medline for English language articles describing adult patient acute DoC diagnostic evaluation and initial management strategies including indications for transfer. Study Selection: Descriptive and interventional studies that address acute adult DoC, their evaluation and initial management, indications for transfer, as well as outcome prognostication. Data Extraction: Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for adult critical care practice. Data Synthesis: Acute adult DoC may be categorized by etiology including structural, functional, infectious, inflammatory, and pharmacologic, the understanding of which drives diagnostic investigation, monitoring, acute therapy, and subsequent specialist care decisions including team-based local care as well as intra- and inter-facility transfer. Conclusions: Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.

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Section: Methodsmentioning

confidence: 99%

State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist

Chang¹,

Provencio²,

Pascual

et al. 2023

Critical Care Medicine

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“…Moreover, it is possible that the metabolic acidosis that characterizes patients with CKD has an effect on cognitive ability, although there are currently few studies on this subject [42]. What is surprising, however, is the lack of correlation between the prevalence of MCI and that of metabolic acidosis, especially in the later stages of CKD [43]. The central nervous system might therefore operate an effective buffering system that prevents large changes in pH and mitigates the latter's cellular effects.…”

Section: Electrolyte Abnormalities and Acid-base Metabolismmentioning

confidence: 99%

Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment

Pépin

Klimkowicz‐Mrowiec

Godefroy

et al. 2023

Euro J of Neurology

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Background: Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition.Methods: Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives.Results: A particular attention on kidney function assessment is suggested during workup for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce.Conclusions: There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.

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“…However, they might suffer from depression [67]. Interestingly, no mild cognitive impairment has been reported in these patients, although it is often present in other forms of CKD [67][68][69][70][71][72][73]. Both PKD1 and PKD2 have large expression in the brain (data from Allen Brain Atlas database and from Human Protein Atlas database).…”

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confidence: 99%

Wall Tension and Tubular Resistance in Kidney Cystic Conditions

Corte

Viggiano

2023

Biomedicines

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The progressive formation of single or multiple cysts accompanies several renal diseases. Specifically, (i) genetic forms, such as adult dominant polycystic kidney disease (ADPKD), and (ii) acquired cystic kidney disease (ACKD) are probably the most frequent forms of cystic diseases. Adult dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by multiple kidney cysts and systemic alterations. The genes responsible for the condition are known, and a large amount of literature focuses on the molecular description of the mechanism. The present manuscript shows that a multiscale approach that considers supramolecular physical phenomena captures the characteristics of both ADPKD and acquired cystic kidney disease (ACKD) from the pathogenetic and therapeutical point of view, potentially suggesting future treatments. We first review the hypothesis of cystogenesis in ADPKD and then focus on ACKD, showing that they share essential pathogenetic features, which can be explained by a localized obstruction of a tubule and/or an alteration of the tubular wall tension. The consequent tubular aneurysms (cysts) follow Laplace’s law. Reviewing the public databases, we show that ADPKD genes are widely expressed in various organs, and these proteins interact with the extracellular matrix, thus potentially modifying wall tension. At the kidney and liver level, the authors suggest that altered cell polarity/secretion/proliferation produce tubular regions of high resistance to the urine/bile flow. The increased intratubular pressure upstream increases the difference between the inside (Pi) and the outside (Pe) of the tubules (∆P) and is counterbalanced by lower wall tension by a factor depending on the radius. The latter is a function of tubule length. In adult dominant polycystic kidney disease (ADPKD), a minimal reduction in the wall tension may lead to a dilatation in the tubular segments along the nephron over the years. The initial increase in the tubule radius would then facilitate the progressive expansion of the cysts. In this regard, tubular cell proliferation may be, at least partially, a consequence of the progressive cysts’ expansion. This theory is discussed in view of other diseases with reduced wall tension and with cysts and the therapeutic effects of vaptans, somatostatin, SGLT2 inhibitors, and potentially other therapeutic targets.

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Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Cited by 18 publications

References 95 publications

State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist

State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist

Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment

Wall Tension and Tubular Resistance in Kidney Cystic Conditions

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