Cognitive function in dialysis patients

Pereira, Arema A.; Weiner, Daniel E.; Scott, Tammy; Sarnak, Mark J.

doi:10.1053/j.ajkd.2004.10.024

Cited by 165 publications

(135 citation statements)

References 122 publications

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“…6 Secondary hyperparathyroidism has also been identified as a potential risk factor for cognitive impairment in CKD. 7 It is postulated that elevated PTH levels interfere with neurotransmission in the CNS by increasing brain calcium content.…”

Section: Chronic Manifestations Of Altered Mental Statusmentioning

confidence: 99%

“…excess PTH may disrupt cerebral function via increased brain calcium content. 7 Several of the toxic metabolic encephalopathies that can occur in CKD patients have very specific pathological mechanisms and will be described briefly as follows. Wernicke's encephalopathy is a result of thiamine (vitamin B1) deficiency and is classically reported to present with a triad of ophthalmoplegia, ataxia and disturbances to cognition or consciousness.…”

Section: Encephalopathy and Deliriummentioning

confidence: 99%

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Neurological complications of chronic kidney disease

2009

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Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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Section: Chronic Manifestations Of Altered Mental Statusmentioning

confidence: 99%

Section: Encephalopathy and Deliriummentioning

confidence: 99%

Neurological complications of chronic kidney disease

2009

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“…The intent is to provide an update to the excellent summary of the epidemiology of cognitive function in dialysis patients by Pereira and co-workers in 2005 (1). While much remains to be learned regarding the multiple causes of cognitive impairment in these populations, the health policy implications of this substantial burden are immediate.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

342

241

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The heavy burden of cognitive impairment in hemodialysis and chronic kidney disease patients has only recently become recognized. Up to 70 percent of hemodialysis patients ages 55 years and older have moderate to severe chronic cognitive impairment, yet it is largely undiagnosed. Recent studies describe the strong graded relation between estimated glomerular filtration rate (eGFR) and cognitive function in CKD patients. The process of conventional hemodialysis may induce recurrent episodes of acute cerebral ischemia, which in turn may contribute to acute decline in cognitive function during dialysis. Thus the worst time to communicate with dialysis patients may be during the hemodialysis session. Both symptomatic and occult, subclinical ischemic cerebrovascular disease appear to play a large role in a proposed model of accelerated vascular cognitive impairment in these populations. Severe cognitive impairment or dementia among hemodialysis patients is associated with an approximately two-fold increased risk of both mortality and dialysis withdrawal. Pre-dialysis cognitive screening and adding dementia to the list of comorbidities on Form 2728 would provide critical information regarding the benefit versus risks of receiving dialysis. It could also improve quality of care and outcomes by raising clinician's awareness of the potential effects of cognitive impairment on medication, fluid, and dietary compliance, and ability to make advance directive decisions among dialysis patients. While much remains to be learned regarding the pathophysiology of cognitive impairment in kidney disease, the public health implications of this substantial burden are immediate.

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“…Hvilke toksiner som påvirker nervesystemet og mekanismene for dette er ukjent. Eldre studier med uremiske personer der man sammenliknet pasienter i dialyse med ikke-behandlede viste at de ubehandlede var mer kognitivt svekket (18). Det er således sannsynlig at «uremiske toksiner» blir fjernet ved dialyse.…”

Section: Cerebral Påvirkning Ved Uremiunclassified

“…Hos nyresviktpasienter er det ofte et høyt homocysteinnivå, økt oksidativt stress og økt nivå av inflammatoriske cytokiner. Dette er faktorer som gir økt risiko for cerebrovaskulaer sykdom og demens (18). Endret kalsium-og fosfatmetabolisme med forstyrrelser i reguleringen av parathyreoideahormon (PTH) kan medføre encefalopati, enten som følge av direkte cerebral påvirkning av forhøyet kalsiumnivå i hjernen eller det kan vaere en langtidseffekt av kalknedslag i vev og arterier.…”

Section: Cerebral Påvirkning Ved Uremiunclassified