Abstract
Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.
Highlights
Chronic kidney disease (CKD) is a type of kidney disease associated with gradual loss of kidney function, decreased glomerular filtration rate or increased albumin excretion in urine
Cerebral microbleeds (CMBs) or microhemorrhages are 5– 10 mm size round, homogenous, hypointense foci that can be visualized by magnetic resonance (MR) susceptibilityweighted (SW) imaging
The presence of microbleeds, especially multiple, predict future stroke—the ones located in regions not typically affected by cerebral amyloid angiopathy are associated with an increased risk of both ischemic and hemorrhagic stroke, while CMBs in regions, where CAA is highly prevalent, is associated with a higher risk of intracerebral hemorrhage [72,73,74]
Summary
Marius Miglinas 1,2, Ugne Cesniene 1, Marta Monika Janusaite 1,2* and Arturas Vinikovas 1,2. Chronic kidney disease (CKD) affects both brain structure and function. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail
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