Diabetes, Albuminuria and the Kidney—Brain Axis

Abstract

Cognitive decline and kidney disease are significant public health problems that share similar characteristics and risk factors. The pathophysiology of the kidney–brain axis is not completely understood, and studies analysing the relationship between the biomarkers of kidney damage and cognitive impairment show different results. This article focuses on the epidemiological and clinical aspects concerning the association of albuminuria, a marker for endothelial dysfunction and microvascular disease, and cognitive impairment in patients with chronic kidney disease, diabetic kidney disease and end-stage kidney disease. Most studies show a positive relationship between albuminuria and cognitive impairment in all groups, but evidence in type 2 diabetes (T2D) patients is limited. We briefly discuss the mechanisms underlying these associations, such as damage to the microvascular circulation, leading to hypoperfusion and blood pressure fluctuations, as well as increased inflammation and oxidative stress, both in the brain and in the kidneys. Further clinical and epidemiological studies developed to understand the interplay between the kidneys and brain diseases will hopefully lead to a reduction in cognitive impairment in these patients.

Chronic Kidney Disease and Cognitive Impairment: The Kidney-Brain Axis

“…Traditional risk factors for cognitive impairment in CKD include aging, female gender [ 9 ], education status, nonwhite ethnicity, diabetes mellitus [ 10 ], hypertension, and cardiovascular disease, which have been extensively reviewed recently [ 7 , 11 , 12 , 13 , 14 ]. Here, we will discuss the nontraditional risk factors in depth, including hyperhomocysteinemia, oxidative stress, low estimated glomerular filtration rate (eGFR), albuminuria, malnutrition, and inflammation (shown in Fig.…”

“…In fact, an 11-year follow-up study elucidated that albuminuria and microalbuminuria, as early markers of endothelial damage of the renal glomeruli, could help predict cognitive decline [8]. However, the intricate pathogenic relationship and exact and cardiovascular disease, which have been extensively reviewed recently [7,[11][12][13][14]. Here, we will discuss the nontraditional risk factors in depth, including hyperhomocysteinemia, oxidative stress, low estimated glomerular filtration rate (eGFR), albuminuria, malnutrition, and inflammation (shown in Fig.…”

Comparison of multiple acupoints combination in the treatment of post-stroke cognitive impairment: A network meta-analysis

“…Some hypotheses may link albuminuria with the pathogenesis of small cerebral vessels, which is related to the aggravation of cognitive impairment, but the specific pathological mechanism is unclear. [ 34 ] In summary, simultaneous treatment of the kidney and brain may be an important breakthrough in the treatment of PSCI using TCM techniques. At the same time, according to the results of this study, it is suggested that clinical workers can perform acupuncture with methods that nourish the kidney and marrow and perform rehabilitation treatment according to the different clinical symptoms and severity of PSCI at the same time to achieve the best therapeutic effect.…”

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

“…In people with diabetes, the pathophysiology of cognitive decline can involve several interrelated factors. Both hyperglycemia and hypoglycemia have detrimental effects on cognition [73]. There are few data on a putative beneficial effect on cognition of glycemia control, even though some interventions are known to improve kidney-related outcomes (e.g., albuminuria).…”

“…Among them, pioglitazone, a synthetic ligand of peroxisome proliferator-activated receptors, and liraglutide, a GLP-1 receptor agonist, have shown neuroprotective effects by diminishing the cognitive decline in experimental and observational studies in humans [75,76]. Future clinical studies of antidiabetic agents and cognitive function might benefit from measuring albuminuria and kidney function [73].…”