Abstract
Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with chronic kidney disease (CKD). These conditions often make worse the quality of life and also lead to longer hospitalizations and higher mortality. Over the past decades, some hypotheses have tried to explain the connection between CKD and neuropsychiatric disorders. The most common hypothesis is based on the occurrence of cerebrovascular disease and accumulated uremic toxins in adult patients with CKD. However, the lack of a direct association between known vascular risk factors (e.g., diabetes and hypertension) with CKD-related cognitive deficits suggests that other mechanisms may also play a role in the pathophysiology shared by renal and neuropsychiatric diseases. This hypothesis is corroborated by the occurrence of neuropsychiatric comorbidities in pediatric patients with CKD preceding vascular damage, and the inconsistent findings on neuroprotective effects of antihypertensives. The aim of this narrative review was to summarize clinical evidence and potential mechanisms that links CKD and brain disorders, specifically in regard to cognitive impairment, anxiety, and depression.
Highlights
Several studies support the association between decreased renal function and cognitive impairement (Kurella et al, 2006; Yaffe et al, 2010; Kurella Tamura et al, 2011; Da Silva et al, 2014)
The study concluded that chronic kidney disease (CKD) is significantly associated with cognitive decline, but this association was independent of the CKD stage and was stronger in the group with moderateto-severe CKD compared with mild-to-moderate CKD (Etgen et al, 2012)
Peritoneal dialysis has been reported to be more effective than hemodialysis in reversing uremic encephalopathy (Wolcott et al, 1988), and the risk of dementia for patients who started on peritoneal dialysis is lower compared with those who started on hemodialysis (Wolfgram et al, 2015)
Summary
Ana Cristina Simões e Silva 1*, Aline Silva Miranda 1,2, Natalia Pessoa Rocha 1,3 and Antônio Lúcio Teixeira 1,3. The lack of a direct association between known vascular risk factors (e.g., diabetes and hypertension) with CKD-related cognitive deficits suggests that other mechanisms may play a role in the pathophysiology shared by renal and neuropsychiatric diseases This hypothesis is corroborated by the occurrence of neuropsychiatric comorbidities in pediatric patients with CKD preceding vascular damage, and the inconsistent findings on neuroprotective effects of antihypertensives. The aim of this narrative review was to summarize clinical evidence and potential mechanisms that links CKD and brain disorders, in regard to cognitive impairment, anxiety, and depression
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