Geriatric Department, APHP, Ambroise Paré University Hospital, Boulogne-Billancourt.
Inserm Unit 1018, Clinical Epidemiology Team, CESP, Hôpital Paul Brousse, Paris-Sud University (UPS) and Versailles Saint-Quentin-en-Yvelines University (UVSQ), Villejuif.
Curr Opin Nephrol Hypertens. 2024 Nov 1;33(6):566-572. doi: 10.1097/MNH.0000000000001017. Epub 2024 Aug 12.
The risk of cognitive impairment is higher in people with CKD than in the general population. The complex relationship between CKD and cognitive dysfunction has not been extensively characterized. Here, we review epidemiological associations, specific patterns of CKD-related cognitive impairment, the underlying mechanisms, and recently published data on relevant biomarkers.
Despite some discrepancies, recent published studies have confirmed that CKD is associated with cognitive function (e.g. incident cognitive events). Although patients with CKD often exhibit impairments in executive functions and attention, it is noteworthy that other cognitive functions (e.g. memory) can be preserved. The key mechanisms described recently include vascular damage, genetic factors, the accumulation of uremic toxins, disruption of the blood-brain barrier, glymphatic system dysfunction, and changes in the gut-brain axis. Kidney function is increasingly seen as a game changer in the interpretation of biomarkers of cognitive impairment and, especially, hallmarks of Alzheimer disease.
The data reviewed here highlight the need for interdisciplinary collaboration between nephrologists and neurologists in the care of patients with CKD at risk of cognitive impairment. In order to further improving diagnosis and therapy, future research must elucidate the mechanisms underlying the CKD-cognitive impairment association and confirm the value of biomarkers.
目的综述：与一般人群相比，慢性肾脏病（CKD）患者的认知障碍风险更高。CKD 与认知功能障碍之间的复杂关系尚未得到充分描述。本文综述了流行病学关联、与 CKD 相关的认知障碍的特定模式、潜在机制，以及最近发表的关于相关生物标志物的数据。
最近的发现：尽管存在一些差异，但最近发表的研究证实 CKD 与认知功能（如认知事件的发生）相关。尽管 CKD 患者常表现出执行功能和注意力受损，但值得注意的是，其他认知功能（如记忆）可能保持完好。最近描述的关键机制包括血管损伤、遗传因素、尿毒症毒素的积累、血脑屏障的破坏、糖质系统功能障碍以及肠脑轴的改变。肾功能越来越被视为解释认知障碍生物标志物的关键因素，尤其是阿尔茨海默病的特征。
总结：本文综述的数据强调了肾脏病学家和神经科医生在 CKD 认知障碍风险患者护理方面进行跨学科合作的必要性。为了进一步改善诊断和治疗，未来的研究必须阐明 CKD 与认知障碍相关的机制，并证实生物标志物的价值。
