Exercise and cognitive function in patients with end‐stage kidney disease

Abstract

In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end‐stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long‐term adverse consequences, including dementia and death. Home‐based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short‐term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long‐term follow‐up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long‐term health outcomes, including dementia prevention and better survival, are yet to be determined.

Effect of a Home-Based Exercise Program on Indices of Physical Function and Quality of Life in Elderly Maintenance Hemodialysis Patients

“…A growing number of studies have demonstrated that patients with CKD commonly have some degree of cognitive impairment and that kidney dysfunction is associated with a more rapid decline in mental function than that in age-matched peers [74][75][76]. Previous studies have also demonstrated that regular exercise generally has a favorable impact on cognitive function in patients with CKD [77]. Mechanisms suggested for these favorable effects of exercise on cognition include improved cerebral blood flow, increased brain volume in the prefrontal cortex and hippocampus, higher brain-derived neurotrophic factor, increases in angiogenesis, neurogenesis, and synaptogenesis, and reductions in inflammatory markers resulting in improved brain plasticity and executive function [76,77].…”

Preferentially Disrupted Core Hubs Within the Default-Mode Network in Patients With End-Stage Renal Disease: A Resting-State Functional Magnetic Resonance Imaging Study

“…Moreover, long-term hemodialysis may result in significantly reduced quality of life, contributing to the development of anxiety and depression. It should be noted that even younger ESRD patients have poorer cognitive function than their peers (7). Therefore, what are the neuropathological mechanisms of cognitive dysfunction in ESRD patients?…”

Interventions Made to Preserve Cognitive Function Trial (IMPCT) study protocol: a multi-dialysis center 2x2 factorial randomized controlled trial of intradialytic cognitive and exercise training to preserve cognitive function

“…Cognitive decline and dementia [ 4 – 6 ] are well-recognized complications of ESKD and hemodialysis [ 7 , 8 ]. One study suggested that only 13% of patients undergoing hemodialysis have normal cognitive function [ 9 ].…”