Madan Pankaj, Kalra Om P, Agarwal Sunil, Tandon Om P
Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Nephrol Dial Transplant. 2007 Feb;22(2):440-4. doi: 10.1093/ndt/gfl572. Epub 2006 Oct 5.
Although end-stage renal disease (ESRD) has been associated with cognitive impairment, the relation between lesser degrees of chronic kidney disease (CKD) and cognitive impairment is less well understood. The objective of this study was to assess the cognitive function in patients with varying severity of CKD using P3 event-related potentials (P3ERPs).
In this cross-sectional study, 15 neurologically asymptomatic (Mini Mental State Examination >24) patients each of CKD stage 3, 4 and 5 (undialysed) were enrolled. Besides this, 15 healthy controls were also studied. All groups were age and sex matched. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease equation. The P300 was studied in all subjects by using standard auditory 'odd-ball' paradigm and the data obtained were statistically analysed.
We noted significant prolongation of P300 latencies as severity of CKD increased from stage 3 (318.8 +/- 28.98 ms) to stage 4 (357 +/- 24.65 ms) (P < 0.002) and from stage 4 to 5 (388.47 +/- 31.67 ms) (P < 0.01). P300 latency in CKD stage 3 was not found to be significantly different from controls (308.4 +/- 13.73 ms). Significant positive correlation was noted between serum creatinine, blood urea and uric acid with P3 latency. Significant negative correlation was noted between GFR, serum calcium and haemoglobin with P3 latency.
Increasing severity of CKD is associated with progressive cognitive decline and this may have important clinical consequences.
尽管终末期肾病（ESRD）与认知障碍有关，但较轻程度的慢性肾脏病（CKD）与认知障碍之间的关系尚不太清楚。本研究的目的是使用P3事件相关电位（P3ERPs）评估不同严重程度CKD患者的认知功能。
在这项横断面研究中，纳入了15例CKD 3期、4期和5期（未透析）且神经系统无症状（简易精神状态检查>24）的患者。此外，还研究了15名健康对照者。所有组在年龄和性别上相匹配。使用肾脏病饮食改良方程估算肾小球滤过率（GFR）。通过标准听觉“odd-ball”范式对所有受试者进行P300研究，并对获得的数据进行统计分析。
我们注意到，随着CKD严重程度从3期（318.8±28.98毫秒）增加到4期（357±24.65毫秒）（P<0.002）以及从4期增加到5期（388.47±31.67毫秒）（P<0.01），P300潜伏期显著延长。未发现CKD 3期的P300潜伏期与对照组（308.4±13.73毫秒）有显著差异。血清肌酐、血尿素和尿酸与P3潜伏期之间存在显著正相关。GFR、血清钙和血红蛋白与P3潜伏期之间存在显著负相关。
CKD严重程度的增加与进行性认知衰退有关，这可能具有重要的临床意义。
