Abstract
Cognitive decline and kidney disease are significant public health problems that share similar characteristics and risk factors. The pathophysiology of the kidney–brain axis is not completely understood, and studies analysing the relationship between the biomarkers of kidney damage and cognitive impairment show different results. This article focuses on the epidemiological and clinical aspects concerning the association of albuminuria, a marker for endothelial dysfunction and microvascular disease, and cognitive impairment in patients with chronic kidney disease, diabetic kidney disease and end-stage kidney disease. Most studies show a positive relationship between albuminuria and cognitive impairment in all groups, but evidence in type 2 diabetes (T2D) patients is limited. We briefly discuss the mechanisms underlying these associations, such as damage to the microvascular circulation, leading to hypoperfusion and blood pressure fluctuations, as well as increased inflammation and oxidative stress, both in the brain and in the kidneys. Further clinical and epidemiological studies developed to understand the interplay between the kidneys and brain diseases will hopefully lead to a reduction in cognitive impairment in these patients.
Highlights
According to the World Health Organization, dementia is a syndrome in which there is deterioration in cognitive functions beyond what might be expected from normal ageing, and it is occasionally preceded by deterioration in emotional control, social behaviour or motivation
Diabetic kidney disease (DKD) is a clinical diagnosis based upon the presence of albuminuria, a decreased estimated glomerular filtration rate or both in diabetes
This theory was derived from type 1 diabetic patients with albuminuria, and at that time, albuminuria was proposed as a biomarker of generalized endothelial dysfunction related to an increase in vascular events, in addition to being a local renal damage marker
Summary
According to the World Health Organization, dementia is a syndrome in which there is deterioration in cognitive functions beyond what might be expected from normal ageing, and it is occasionally preceded by deterioration in emotional control, social behaviour or motivation. The early identification of patients at higher risk is essential to achieve better surveillance and earlier diagnosis to conduct effective preventive and treatment strategies for dementia [3]. Among these high-risk patients, those with diabetes and/or kidney disease might be interesting, given that both are clinical conditions with a higher prevalence of cognitive disorders than what is present in the general population. Diabetic kidney disease (DKD) is a clinical diagnosis based upon the presence of albuminuria, a decreased estimated glomerular filtration rate (eGFR) or both in diabetes. We provided a summary of the main mechanisms underlying these associations and examined the different treatment strategies aimed at reducing cognitive impairment in diabetes
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