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. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.

Association between Cerebral Oxygenation, as Evaluated with Near-Infrared Spectroscopy, and Cognitive Function in Patients Undergoing Hemodialysis

“…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.…”

“…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.…”

Effect of oral intake of royal jelly on endothelium function in hemodialysis patients: study protocol for multicenter, double-blind, randomized control trial

“…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 ].…”

Kidney Function Is Not Related to Brain Amyloid Burden on PET Imaging in The 90+ Study Cohort

“…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 ).…”

“…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 ).…”