Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy

Abstract

Chronic kidney disease (CKD) is a highly prevalent condition in the world. Neurological, psychological, and cognitive disorders, related to CKD, could contribute to the morbidity, mortality, and poor quality of life of these patients. The aim of this study was to assess the neurological, psychological, and cognitive imbalance in patients with CKD on conservative and replacement therapy.Seventy-four clinically stable patients affected by CKD on conservative therapy, replacement therapy (hemodialysis (HD), peritoneal dialysis (PD)), or with kidney transplantation (KT) and 25 healthy controls (HC), matched for age and sex were enrolled. Clinical, laboratory, and instrumental examinations, as renal function, inflammation and mineral metabolism indexes, electroencephalogram (EEG), psychological (MMPI-2, Sat P), and cognitive tests (neuropsychological tests, NPZ5) were carried out.The results showed a significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (P = 0.008, P < 0.001, P = 0.051), a positive correlation between relative power of delta band and C-reactive protein (CRP) (P < 0.001) and a negative correlation between estimated glomerular filtration rate (eGFR) (P < 0.001) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) (P < 0.001), in all the samples. Qualitative analysis of EEG showed alterations of Grade 2 (according to Parsons–Smith classification) in patients on conservative therapy, and Grade 2–3 in KT patients. The scales of MMPI-2 hysteria and paranoia, are significantly correlated with creatinine, eGFR, serum nitrogen, CRP, 1,25-(OH)2D3, intact parathyroid hormone (iPTH), phosphorus, and cynical and hysterical personality, are correlated with higher relative power of delta (P = 0.016) and theta band (P = 0.016). Moreover, all NPZ5 scores showed a significant difference between the means of nephropathic patients and the means of the HC, and a positive correlation with eGFR, serum nitrogen, CRP, iPTH, and vitamin D.In CKD patients, simple and noninvasive instruments, as EEG, and cognitive-psychological tests, should be performed and careful and constant monitoring of renal risk factors, probably involved in neuropsychological complications (inflammation, disorders of mineral metabolism, electrolyte disorders, etc.), should be carried out. Early identification and adequate therapy of neuropsychological, and cognitive disorders, might enable a better quality of life and a major compliance with a probable reduction in the healthcare costs.

Frail phenotype is associated with distinct quantitative electroencephalographic findings among end-stage renal disease patients: an observational study

“…These results indirectly suggested a generalized suppression of alpha power. Similar findings of significant alpha and beta suppression with delta accentuation were also described in a recent study done in stable patients with CKD and ESRD [ 29 ], lending support to the validity of our results.…”

Quality of life on hemodialysis and inflammation: a descriptive analysis

“…In addition, the release of inflammatory mediators during hemodialysis treatment is indicated as an aggravating factor for the increase in morbidity, mortality, and decline in the subjective perception of overall quality of life ( 7 ). In our study, we chose inflammatory markers that had already been described in other studies.…”

Electroencephalogram findings in chronic kidney disease

“…& Kiernan MC. In 2016,Lai et al, [22] studied neurologic disorders in 74 patients affected by CKD and the results showed significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (p=0.008 , p<0.001 , p=0.051) respectively. Also, Röhl et al, [23] found out that electrical power was most prominent in delta, theta and alpha frequencies in the temporal and central brain areas.…”