de Donato Antonio, Buonincontri Veronica, Borriello Gianmarco, Martinelli Giuseppe, Mone Pasquale
Dipartimento di Salute Mentale, Fisica e Medicina Preventiva, Università degli Studi della Campania "Luigi Vanvitelli,", Naples, Italy.
ASL Napoli, Naples, Italy.
Kidney Blood Press Res. 2022;47(8):493-505. doi: 10.1159/000522132. Epub 2022 Apr 4.
Chronic kidney disease (CKD) is one of the most common diseases in adult age, and it is typical of older adults. Recent data suggest that almost half of the elders have CKD. It is now clear that CKD is accompanied, in the early stages, by cognitive impairment, together with depression and subtle abnormalities in motor control (such as gait and balance alterations).
Several data suggest a link between brain dopamine and kidney diseases. Metabolic syndrome and diabetes can affect dopamine neuron survival (leading to Parkinson's disease). Several uremic toxins in CKD (uric acid, indoxyl sulfate) and trace elements accumulating in CKD (aluminum, manganese) can also modify the dopaminergic system. Hormones produced by the kidney such as vitamin D are neuroprotective for dopamine neurons. Dopaminergic drugs are useful for the treatment of a common sleep disorder in CKD, the restless legs syndrome. However, experiments on animal models of CKD show conflicting results regarding a modification of dopamine neurons.
Several observations suggest a limited relevance of the dopaminergic system in CKD-related cognitive impairment. However, a common sleep disturbance in CKD, the restless legs syndrome, improves with dopaminergic drugs. Therefore, it remains to be established the role of the dopamine system in subtle motor dysfunction observed in CKD, such as tremors, gait alterations, and central sleep apnea.
慢性肾脏病（CKD）是成年人中最常见的疾病之一，在老年人中尤为典型。近期数据表明，几乎一半的老年人患有CKD。目前已明确，CKD在早期阶段伴有认知障碍，同时伴有抑郁以及运动控制方面的细微异常（如步态和平衡改变）。
多项数据表明脑多巴胺与肾脏疾病之间存在联系。代谢综合征和糖尿病会影响多巴胺神经元的存活（导致帕金森病）。CKD中的几种尿毒症毒素（尿酸、硫酸吲哚酚）以及CKD中蓄积的微量元素（铝、锰）也会改变多巴胺能系统。肾脏产生的激素如维生素D对多巴胺神经元具有神经保护作用。多巴胺能药物可用于治疗CKD中一种常见的睡眠障碍——不安腿综合征。然而，在CKD动物模型上进行的实验对于多巴胺神经元的改变呈现出相互矛盾的结果。
多项观察结果表明多巴胺能系统在CKD相关认知障碍中的相关性有限。然而，CKD中一种常见的睡眠障碍——不安腿综合征，使用多巴胺能药物后症状会改善。因此，多巴胺系统在CKD中观察到的细微运动功能障碍（如震颤、步态改变和中枢性睡眠呼吸暂停）中的作用仍有待确定。
