Kanbay Mehmet, Ozbek Lasin, Guldan Mustafa, Abdel-Rahman Sama Mahmoud, Sisman Uluman, Mallamaci Francesca, Zoccali Carmine
Division of Nephrology, Department of Internal Medicine, Koc University, School of Medicine, Istanbul, Turkey.
Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
Eur J Clin Invest. 2025 Jun;55(6):e70045. doi: 10.1111/eci.70045. Epub 2025 Apr 11.
Cognitive impairment is a prevalent complication in chronic kidney disease (CKD), ranging from mild deficits in early stages to more severe conditions, such as mild cognitive impairment and dementia in advanced stages. CKD patients exhibit reduced performance in memory, attention, language, visuospatial abilities and executive functions.
Contributing factors include uraemic toxins, structural brain changes, blood-brain barrier dysfunction, anaemia and comorbidities like diabetes mellitus. Malnutrition, affecting nearly half of CKD patients, exacerbates cognitive decline through inflammation, oxidative stress and protein-energy wasting. Nutritional deficiencies, particularly in protein, vitamin D, B vitamins, omega-3 fatty acids and antioxidants, are linked to impaired cognition. Emerging evidence highlights the role of the gut-brain axis, with gut-derived uraemic toxins and microbiome alterations contributing to cognitive dysfunction. Processed foods and microplastics further compound risks by promoting inflammation and neurotoxicity. Dialysis and kidney transplantation offer opportunities for cognitive recovery, though challenges remain, particularly in haemodialysis patients. Nutritional interventions, including tailored protein intake, micronutrient supplementation and dietary counselling, are critical for mitigating cognitive decline. Addressing CKD comorbidities, such as anaemia and diabetes through targeted nutritional and pharmacological strategies, improves outcomes. Integrating psychological and social support enhances quality of life, given the high prevalence of anxiety and depression in CKD patients.
Future research should focus on personalized nutrition, gut microbiota modulation and routine cognitive assessments to optimise care. A holistic approach combining medical, nutritional and psychosocial strategies is essential for improving cognitive and overall health in CKD patients.
认知障碍是慢性肾脏病（CKD）中一种常见的并发症，从早期的轻度缺陷到更严重的情况，如晚期的轻度认知障碍和痴呆。CKD患者在记忆、注意力、语言、视觉空间能力和执行功能方面表现下降。
促成因素包括尿毒症毒素、脑结构改变、血脑屏障功能障碍、贫血以及糖尿病等合并症。营养不良影响了近一半的CKD患者，通过炎症、氧化应激和蛋白质-能量消耗加剧认知衰退。营养缺乏，尤其是蛋白质、维生素D、B族维生素、ω-3脂肪酸和抗氧化剂的缺乏，与认知功能受损有关。新出现的证据突出了肠-脑轴的作用，肠道衍生的尿毒症毒素和微生物群改变导致认知功能障碍。加工食品和微塑料通过促进炎症和神经毒性进一步增加风险。透析和肾移植为认知恢复提供了机会，尽管挑战仍然存在，尤其是在血液透析患者中。营养干预，包括量身定制的蛋白质摄入量、微量营养素补充和饮食咨询，对于减轻认知衰退至关重要。通过有针对性的营养和药物策略解决CKD合并症，如贫血和糖尿病，可改善治疗结果。鉴于CKD患者中焦虑和抑郁的高患病率，整合心理和社会支持可提高生活质量。
未来的研究应侧重于个性化营养、肠道微生物群调节和常规认知评估，以优化治疗。结合医学、营养和心理社会策略的整体方法对于改善CKD患者的认知和整体健康至关重要。
