Neuropsychological Function in Renal Disease and Its Treatment

Adult Chronic Kidney Disease: Neurocognition in Chronic Renal Failure

“…The kidneys are responsible for a variety of functions including: regulating urinary output in relation to dietary salt, water, and mineral intake; the removal of metabolic end-products including urea, uric acid, and creatinine; the regulation of blood pressure through blood volume modulation; the production of erythropoietin (a peptide hormone that is involved in the control of red blood cell production by the bone marrow); the production of the active form of vitamin D; and gluconeogenesis (synthesis of glucose from non-carbohydrate sources such as protein and triglycerides) (Burrows-Hudson 2005; Eaton and Pooler 2004;Lee et al 2004;Lieberthal and Nigam 2000;Pliskin et al 2001). Failure of the kidneys to remove metabolic end-products from the blood results in waste buildup, leading eventually to uremia.…”

“…Creatinine is a non-toxic by-product of muscle metabolism and is used as an endogenous marker because the rate of production is relatively stable (roughly 10-20 mg creatinine/kg body weight per day, i.e., proportional to muscle mass), it is not protein bound, and it is freely filtered (Kidney/Disease Outcome Quality Initiative [K/DOQI 2002]; Pliskin et al 2001). The most commonly used clinical method for calculation of glomerular filtration rate involves the assessment of serum creatinine after accounting for factors that affect it such as age, mass and gender (Burrows-Hudson 2005;El Nahas and Bello 2005;Levey et al 2003;K/DOQI 2002).…”

“…A smaller group of individuals experience chronic kidney disease due to a range of autoimmune diseases such as systemic lupus erythematosus, systemic vasculitis, scleroderma, and rheumatoid arthritis although renal involvement is not typically a common problem in the latter two conditions (Cunnard and Kelly 2003;O'Callaghan 2004;Pliskin et al 2001).…”

“…Dialysis fluid circulates on the other side of this large surface area membrane, allowing wastes to flow down their concentration gradients out of the blood and needed molecules, such as calcium, to be delivered to the patient (Pliskin et al 2001). Adequate hemodialysis is that level of treatment that will minimize long-term mortality and morbidity, be fiscally efficient, and most of all, provide patients with the best possible quality of life (Leypoldt 2005).…”

“…Over the 6 months a 7% improvement in visuomotor processing speed and a 32% improvement in attention and working memory were seen sometimes referred to as intermittent dialysis, a label emphasizing the accumulation of toxins that may take place between sessions (Pliskin et al 2001). …”