Franco Álvaro de Oliveira, Starosta Rodrigo Tzovenos, Roriz-Cruz Matheus
Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brasil.
Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brasil.
J Bras Nefrol. 2019 Jan-Mar;41(1):103-111. doi: 10.1590/2175-8239-JBN-2018-0033. Epub 2018 Aug 9.
One of the mechanisms proposed for chronic kidney disease (CKD)-related cognitive impairment is the accumulation of uremic toxins due to the deterioration of the renal clearance function. Cognition can be categorized into five major domains according to its information processing functions: memory, attention, language, visual-spatial, and executive. We performed a review using the terms 'uric acid', 'indoxyl sulfate', 'p-cresyl sulfate', 'homocysteine', 'interleukins' and 'parathyroid hormone'. These are the compounds that were found to be strongly associated with cognitive impairment in CKD in the literature. The 26 selected articles point towards an association between higher levels of uric acid, homocysteine, and interleukin 6 with lower cognitive performance in executive, attentional, and memory domains. We also reviewed the hemodialysis effects on cognition. Hemodialysis seems to contribute to an amelioration of CKD-related encephalopathic dysfunction, although this improvement occurs more in some cognitive domains than in others.
慢性肾脏病（CKD）相关认知障碍的一种可能机制是，由于肾脏清除功能恶化，尿毒症毒素积聚。根据信息处理功能，认知可分为五个主要领域：记忆、注意力、语言、视觉空间和执行功能。我们使用“尿酸”“硫酸吲哚酚”“对甲酚硫酸酯”“同型半胱氨酸”“白细胞介素”和“甲状旁腺激素”等术语进行了一项综述。这些化合物在文献中被发现与CKD中的认知障碍密切相关。所选的26篇文章表明，尿酸、同型半胱氨酸和白细胞介素6水平升高与执行功能、注意力和记忆领域的较低认知表现之间存在关联。我们还综述了血液透析对认知的影响。血液透析似乎有助于改善CKD相关的脑病功能障碍，尽管这种改善在某些认知领域比其他领域更明显。
