Dahdaleh Samer, Malhotra Paresh
Division of Brain Sciences, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
Department of Clinical Neurology, Imperial College Healthcare NHS Trust, London, UK.
Curr Treat Options Neurol. 2019 Mar 11;21(3):13. doi: 10.1007/s11940-019-0553-6.
Most clinical neurologists will have come across individuals receiving renal replacement therapy who have developed a neurological complication, and neurologists working in, or close to, hospitals with a Renal Unit will be very aware of the range of central nervous system (CNS) complications that may develop in these patients. These can often be difficult to differentiate from disorders relating to renal failure or systemic conditions leading to kidney disease and can in fact arise from the interaction between underlying disease and the side effects of treatment. Patients with renal disease frequently have multiple comorbidities, and it is necessary to take a generally inclusive approach to diagnosis and treatment.
Unfortunately, there is a lack of specific high-quality evidence for a number of CNS complications of renal replacement therapy. Here, we review the major CNS complications of dialysis and transplantation, discussing evidence for treatments where available and detailing standard management approaches where evidence is scarce. Given the lack of specific evidence for interventions in the treatment of CNS complications of renal replacement therapy, it is often necessary to take an individualised approach based on comorbidities and applying findings from the general population. In these complex patients, we must stress the importance of collaborative working between neurologists and renal physicians when treating this complex patient group.
大多数临床神经科医生都会遇到接受肾脏替代治疗后出现神经并发症的患者，而在设有肾脏科的医院工作或临近此类医院工作的神经科医生会非常清楚这些患者可能出现的一系列中枢神经系统（CNS）并发症。这些并发症往往难以与肾衰竭相关疾病或导致肾脏疾病的全身性疾病相区分，实际上可能源于基础疾病与治疗副作用之间的相互作用。肾病患者常常伴有多种合并症，因此有必要采取一种较为全面的诊断和治疗方法。
不幸的是，对于肾脏替代治疗的一些中枢神经系统并发症，缺乏具体的高质量证据。在此，我们综述透析和移植的主要中枢神经系统并发症，讨论现有治疗方法的证据，并详细说明证据不足时的标准管理方法。鉴于在肾脏替代治疗的中枢神经系统并发症治疗中缺乏针对干预措施的具体证据，通常有必要根据合并症并应用一般人群的研究结果采取个体化方法。在这些复杂的患者中，我们必须强调神经科医生和肾脏科医生在治疗这一复杂患者群体时协作的重要性。
