Neurological complications of chronic kidney disease

Krishnan, Arun V.; Kiernan, Matthew C.

doi:10.1038/nrneurol.2009.138

Cited by 158 publications

(160 citation statements)

References 135 publications

(37 reference statements)

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“…When compared with the general population, patients on dialysis have higher mortality rates (Pecoits-Filho et al, 2005;de Jager et al, 2009). Moreover, they suffer from age-related diseases with a higher frequency and more rapid progression, among which there are cardiovascular diseases (London, 2000;Nolan, 2005;de Jager et al, 2009), cognitive impairment and dementia (Krishnan & Kiernan, 2009), metabolic bone disease (Nickolas et al, 2008), and dysfunction of the immune system (de Jager et al, 2009). Biologically, this clinically accelerated senescence is attributed to disturbed levels of metabolites and signaling molecules, such as urea, advanced glycosylation endproducts, homocysteine, and endothelin (Makita et al, 1994;Amann & Ritz, 1998;Blacher et al, 1998;Cohen, 2007).…”

Section: Introductionmentioning

confidence: 99%

Senescence rates in patients with end‐stage renal disease: a critical appraisal of the Gompertz model

et al. 2010

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SummaryThe most frequently used model to describe the exponential increase in mortality rate over age is the Gompertz equation. Logarithmically transformed, the equation conforms to a straight line, of which the slope has been interpreted as the rate of senescence. Earlier, we proposed the derivative function of the Gompertz equation as a superior descriptor of senescence rate. Here, we tested both measures of the rate of senescence in a population of patients with end-stage renal disease. It is clinical dogma that patients on dialysis experience accelerated senescence, whereas those with a functional kidney transplant have mortality rates comparable to the general population. Therefore, we calculated the age-specific mortality rates for European patients on dialysis (n = 274 221; follow-up = 594 767 person-years), for European patients with a functioning kidney transplant (n = 61 286; followup = 345 024 person-years), and for the general European population. We found higher mortality rates, but a smaller slope of logarithmic mortality curve for patients on dialysis compared with both patients with a functioning kidney transplant and the general population (P < 0.001). A classical interpretation of the Gompertz model would imply that the rate of senescence in patients on dialysis is lower than in patients with a functioning transplant and lower than in the general population. In contrast, the derivative function of the Gompertz equation yielded the highest senescence rates for patients on dialysis, whereas the rate was similar in patients with a functioning transplant and the general population. We conclude that the rate of senescence is better described by the derivative function of the Gompertz equation.

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Section: Introductionmentioning

confidence: 99%

Senescence rates in patients with end‐stage renal disease: a critical appraisal of the Gompertz model

et al. 2010

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“…Further cognitive impairment, manifesting typically as vascular dementia, develops in a considerable proportion of patients on dialysis and improves with renal transplantation (Krishnan and Kiernan 2009).…”

Section: Introductionmentioning

confidence: 99%

Psychomotor functions at various weeks of chronic renal failure in rats

Chandanathil¹,

Upadhya

Bhat³

2014

Cogn Neurodyn

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In chronic renal failure there is a gradual retention of substances in the tissues and body fluids, called as uremic retention toxins, which can bring about a number of biochemical activities in the body. Chronic renal insufficiency also leads to progressive behavioural conflict. Uremic toxins can affect both the central and the peripheral nervous system. Uremic encephalopathy is also associated with problems in cognition and memory. To study the psychomotor functional disorders in rats with progressive chronic renal failure surgical nephrectomy was done by resection method. The animals were grouped into two control groups, Sham control (SC) and normal control (NC) and two uremic groups, moderate uremia (G M ) and severe uremia (G S ). Psychomotor analysis was done by passive avoidance and open field in these animals at 4, 8, 12, and 16 weeks. After the incubation period, the nephrectomised groups (G M and G S ) showed significant changes in exploratory, locomotor and emotional behaviour when compared to the controls (NC and SC). Psychomotor changes involve poor cognition, reduced memory, reduced locomotor activity and decreased exploratory drive and emotional disturbance like increased fear during the initial stages. During the later stages a restless behaviour was noticed, associated with diminished fear.

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“…Cognitive dysfunction increases in prevalence with CKD severity, potentially affecting up to 80% of patients, especially in populations of older persons (1). A 0.5-unit decrease in 1/SCr (eg.…”

Section: Introductionmentioning

confidence: 99%

Progression of Cognitive Dysfunction in Elderly Chronic Kidney Disease Patients in a Veteran's Institution in Central Taiwan: a 3-Year Longitudinal Study

et al. 2012

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Objective A strong positive correlation between estimated glomerular filtration rate (eGFR) multiplied by follow-up time and memory function has been demonstrated previously. The purpose of this study was to investigate the factors affecting progression of cognitive dysfunction in the elderly with different levels of kidney function. Methods In April 2002, a prospective study on progression of cognitive function was conducted on 356 elderly people. All participants received a comprehensive geriatric assessment, serum biochemical test, homeostasis model assessment (HOMA), and a genetic polymorphism study, including polymorphism of apolipoprotein E (APOE), Cystatin, C-reactive protein (CRP) and tumor necrosis factor (TNF). Lean body massadjusted eGFR was used to evaluate severity of chronic kidney disease (CKD), and a clinical dementia rating scale was used to assess cognitive dysfunction. Patients were stratified according to eGFR ( 49 mL/min and <49 mL/min). Results Using multivariate logistic regression models, older age (OR=1.27, 95% CI=1.00-1.61) was associated with a high risk for progression of cognitive function in patients with a relatively low eGFR. In patients with lower eGFR, higher mini-mental state examination (MMSE) scores (OR=0.23, 95% CI=0.10-0.54) were correlated with a low risk for progression of cognition, while in patients with higher eGFR, higher MMSE scores (OR=0.39, 95% CI=0.23-0.65) were less correlated with cognitive dysfunction. However, elevated serum plasminogen activator inhibitor-1 (PA1-1) was associated with a high risk for cognitive dysfunction (OR=1.06, 95% CI=1.01-1.11) in patients with a better eGFR. Conclusion Age, MMSE score and serum PAI-1 were found to be factors that predicted cognitive dysfunction at different functional levels of CKD.

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Neurological complications of chronic kidney disease

Cited by 158 publications

References 135 publications

Senescence rates in patients with end‐stage renal disease: a critical appraisal of the Gompertz model

Senescence rates in patients with end‐stage renal disease: a critical appraisal of the Gompertz model

Psychomotor functions at various weeks of chronic renal failure in rats

Progression of Cognitive Dysfunction in Elderly Chronic Kidney Disease Patients in a Veteran's Institution in Central Taiwan: a 3-Year Longitudinal Study

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