Department of Neurology, Medical University of Warsaw, Warsaw, Poland.
1st Department of Nephrology and Transplantology, Medical University of Bialystok, Białystok, Poland.
Kidney Blood Press Res. 2022;47(7):459-466. doi: 10.1159/000521907. Epub 2022 Apr 21.
Chronic kidney disease (CKD) affects the crosstalk between organs in the body and vast majority of studies were devoted to the interactions between the kidneys and the cardiovascular system. As of today, there is more evidence of the kidney and the central nervous system connections.
Indeed, CKD and in particular dialysis therapy is linked to the increased prevalence of neurological complications, such as cerebrovascular disorders, movement disorders, cognitive impairment, and depression. Both traditional cardiovascular risk factors (such as diabetes, hypertension, and lipid disorders), nontraditional risk factors (such as uremic toxins, anemia, and secondary hyperparathyroidism) may predispose CKD patients to neurological disorders. Likewise, cognitive problems occur more commonly in kidney transplant recipients, regardless of age, than in the general population, but the prevalence is still understudied. Cognitive impairment is associated with a higher risk of hospitalization, mortality, decreased quality of life, or health care costs in kidney transplant recipients. Here, we review (i) the potential clinical impact of kidney transplantation on cerebrovascular and neurological complications, (ii) evaluation of patients with cognitive impairment for kidney transplantation (iii) the potential impact of cognitive impairment on waitlisted and transplanted patients on patient care, and (iv) unmet medical needs.
Cognitive impairment in kidney transplant recipients is an underestimated, underrecognized but clinically relevant problem. The screening for cognitive declines after kidney transplantation is not yet a routine practice. Several prospective and cross-sectional studies reported improvement across some of the assessed cognitive domains after transplantation.
慢性肾脏病（CKD）会影响体内器官之间的相互作用，而绝大多数研究都致力于研究肾脏与心血管系统之间的相互作用。截至目前，越来越多的证据表明肾脏与中枢神经系统之间存在关联。
事实上，CKD，尤其是透析治疗与神经并发症的高发有关，如脑血管疾病、运动障碍、认知障碍和抑郁症。传统心血管危险因素（如糖尿病、高血压和血脂紊乱）和非传统危险因素（如尿毒症毒素、贫血和继发性甲状旁腺功能亢进）都可能使 CKD 患者易患神经疾病。同样，无论年龄大小，肾移植受者的认知问题比一般人群更为常见，但患病率仍研究不足。认知障碍与肾移植受者的住院风险、死亡率、生活质量下降或医疗费用增加相关。在这里，我们综述了（i）肾移植对脑血管和神经并发症的潜在临床影响，（ii）对认知障碍患者进行肾移植的评估，（iii）认知障碍对等候和移植患者的潜在影响对患者护理，以及（iv）未满足的医疗需求。
肾移植受者的认知障碍是一个被低估、被忽视但具有临床相关性的问题。肾移植后认知能力下降的筛查尚未成为常规做法。一些前瞻性和横断面研究报告称，移植后一些评估认知领域的认知能力有所改善。
