INSERM U1088, University of Picardie Jules Verne, Amiens, France Division of Pharmacology, Amiens University Hospital, Amiens, France.
Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France INSERM U1018, CESP, Team 5, Villejuif, France Versailles St-Quentin University-UVSQ, UMRS 1018, Montigny, France.
Nephrol Dial Transplant. 2016 Oct;31(10):1606-14. doi: 10.1093/ndt/gfv315. Epub 2015 Sep 10.
Chronic kidney disease (CKD) is associated with a high prevalence of cerebrovascular disorders such as stroke, white matter diseases, intracerebral microbleeds and cognitive impairment. This situation has been observed not only in end-stage renal disease patients but also in patients with mild or moderate CKD. The occurrence of cerebrovascular disorders may be linked to the presence of traditional and non-traditional cardiovascular risk factors in CKD. Here, we review current knowledge on the epidemiological aspects of CKD-associated neurological and cognitive disorders and discuss putative causes and potential treatment. CKD is associated with traditional (hypertension, hypercholesterolaemia, diabetes etc.) and non-traditional cardiovascular risk factors such as elevated levels of oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anaemia and uraemic toxins. Clinical and animal studies indicate that these factors may modify the incidence and/or outcomes of stroke and are associated with white matter diseases and cognitive impairment. However, direct evidence in CKD patients is still lacking. A better understanding of the factors responsible for the elevated prevalence of cerebrovascular diseases in CKD patients may facilitate the development of novel treatments. Very few clinical trials have actually been performed in CKD patients, and the impact of certain treatments is subject to debate. Treatments that lower LDL cholesterol or blood pressure may reduce the incidence of cerebrovascular diseases in CKD patients, whereas treatment with erythropoiesis-stimulating agents may be associated with an increased risk of stroke but a decreased risk of cognitive disorders. The impact of therapeutic approaches that reduce levels of uraemic toxins has yet to be evaluated.
慢性肾脏病（CKD）与脑血管疾病（如中风、白质疾病、脑内微出血和认知障碍）的高发率相关。这种情况不仅在终末期肾病患者中观察到，在轻度或中度 CKD 患者中也观察到。脑血管疾病的发生可能与 CKD 中存在传统和非传统心血管危险因素有关。在这里，我们回顾了与 CKD 相关的神经和认知障碍的流行病学方面的现有知识，并讨论了潜在的原因和潜在的治疗方法。CKD 与传统（高血压、高胆固醇血症、糖尿病等）和非传统心血管危险因素相关，如氧化应激水平升高、慢性炎症、内皮功能障碍、血管钙化、贫血和尿毒症毒素。临床和动物研究表明，这些因素可能改变中风的发生率和/或结局，并与白质疾病和认知障碍相关。然而，在 CKD 患者中仍然缺乏直接证据。更好地了解导致 CKD 患者脑血管疾病高发的因素可能有助于开发新的治疗方法。实际上，在 CKD 患者中仅进行了少数临床试验，并且某些治疗方法的影响存在争议。降低 LDL 胆固醇或血压的治疗可能会降低 CKD 患者发生脑血管疾病的风险，而使用促红细胞生成素治疗可能与中风风险增加但认知障碍风险降低相关。降低尿毒症毒素水平的治疗方法的影响仍有待评估。
