Clinical characteristics and pathogenetic mechanisms of development of cognitive disfucntion in chronic kidney disease patients


Citar

Texto integral

Acesso aberto Acesso aberto
Acesso é fechado Acesso está concedido
Acesso é fechado Acesso é pago ou somente para assinantes

Resumo

Aim. Assessment of cognitive dysfunction risk factors and it’s association with vascular remodeling in patients with chronic kidney disease (CKD). Methods. 51 patients with CKD (age 53±10 years): 20 — with CKD І-ІІ stage, 20 — CKD III stage, 11 — CKD IV stage were included into the study. Glomerular filtration rate was calculated by MDRD formula. Neuropsychological tests were used for diagnosing of cognitive dysfunction. Magnetic resonance tomography (MRT) of brain, ultrasound scanning of carotid arteries and measurement of carotid-femoral pulse wave velocity were performed. Results. In patients with CKD III — IV more often, than patients with CKD III — IV showed signs of cognitive dysfunction. CKD III — IV is independent risk factor for cognitive impairment (Or 27,32, 95%, CI 4,3 — 172,9, p<0,001). Cognitive dysfunction is connected with homocysteine, creatinine level, anemia, visceral obesity and age. In patients with CKD and cognitive dysfunction MRT shown focal lesions in 9 (30%) of patients, leucoareosis in 7 (2,3%), lateral ventricular widening in 15 (50%). Carotid intima-media thickness and carotid-femoral pulse wave velocity were also associated with frequency and severity of cognitive dysfunction. Conclusion. Chronic kidney disease is a risk factor for cognitive dysfunction.

Texto integral

Acesso é fechado

Bibliografia

  1. Raphael K.L., Wei G., Greene T. et al. Cognitive function and the risk of death in chronic kidney disease. Am. J. Nephrol. 2012; 35(1): 49-57.
  2. Дамулин И.В. Когнитивные нарушения при сосудистых заболеваниях головного мозга: некоторые аспекты диагностики и терапии. Фарматека. 2011; 19: 20-28.
  3. Leys D., Englund E., Erkinjuntti T. Vascular dementia. In: Evidence-based Dementia Practice. Ed. by N.Qizilbash et al. Oxford etc.: Blackwell Science, 2002.460-287.
  4. Etgen T., Chonchol M., Förstl H., et al. Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol. 2012;35(5): 474-825.
  5. Collins A.J., Foley R.N., Herzog C. et al. US Renal Data System 2010 Annual Data Report. Am J Kidney Dis. 2011; 57: 1-526.
  6. Захаров В.В., Яхно Н.Н. Когнитивные расстройства в пожилом и старческом возрасте. Методическое пособие для врачей. М.: Медицина 2005: 27-31.
  7. Кутырина И.А. Ремоделирование сосудов при хронической почечной недостаточности. В: Мухин Н.А (ред). Нефрология. Национальное руководство. М.: «Гэотар-Медиа»; 2009: 608-616.
  8. Kurella Tamura M., Xie D., Yaffe K. et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011; 6(2): 248-256.
  9. Yaffe K., Ackerson L., Kurella Tamura M. et. al. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J. Am Geriatr. Soc. 2010; 58(2): 338-345.
  10. Khatri M., Nickolas T., Moon Y.P., Paik M.C. CKD Associates with Cognitive Decline. J. Am. Soc. Nephrol. 2009; 20(11): 2427-2432.
  11. Helmer C., Stengel B., Metzger M. et al. Chronic kidney disease, cognitive decline, and incident dementia: the 3C Study. Neurology. 2011; 77(23): 2043-2051.
  12. Tamura M.K., Wadley V., Yaffe K. et al. Kidney function and cognitive impairment in US adults: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Kidney Dis. 2008; 52: 227-234.
  13. Kurella M., Yaffe K., Shlipak M.G., et al. Chronic kidney disease and cognitive impairment in menopausal women. Am J Kidney Dis. 2005; 45: 66- 76.
  14. Seliger S.L., Siscovick D.S., Stehman-Breen C.O. et al. Moderate renal impairment and risk of dementia among older adults: The Cardiovascular Health Cognition study. J Am Soc Nephrol. 2004; 15: 1904-1911.
  15. Hailpern S.M., Melamed M.L., Cohen H.W. et al. Moderate Chronic Kidney Disease and CognitiveFunction in Adults 20 to 59 Years of Age: Third National Health and Nutrition Examination Survey (NHANES III). J. Am. Soc. Nephrol. 2007; 18: 2205-2213.
  16. Sarbjit V. Jassal, Roscoe J., LeBlanc D. et al. Differential impairment of psychomotor efficiency and processing speed in patients with chronic kidney disease. Int Urol Nephrol 2008; 40: 849-854.
  17. Elias M.F., Elias P.K., Seliger S.L. et al. Chronic kidney disease, creatinine and cognitive functioning. Nephrol Dial Transplant. 2009; 24: 2446-2452.
  18. Vermeer S.E., Longstreth W.T. Jr, Koudstaal P.J. Silent brain infarcts: A systematic review. Lancet Neurol 2007; 6: 611-619.
  19. Seliger S.L., Longstreth W.T. Jr, Katz R. et al. Cystatin C and subclinical brain infarction. J. Am. Soc. Nephrol 2005; 16: 3721-3727.
  20. Debette S., Beiser A., DeCarli C. et al. Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: The Framingham Offspring Study. Stroke 2010; 41: 600-606.
  21. Kim C.D., Lee H.J., Kim D.J. et. al. High prevalence of leukoaraiosis in cerebralmagnetic resonance images of patients on peritoneal dialysis. Am J Kidney Dis 2007; 50: 98-107.
  22. Longstreth W.T. Jr, Manolio T.A., Arnold A. et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke 1996; 27: 1274-1282.
  23. Blacher J., Guérin A.P., Pannier B. et al. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999; 99: 2434-2439.
  24. Szeto C.C., Chow K.M., Woo K.S. et al. Carotid intima media thickness predicts cardiovascular diseases in Chinese predialysis patients with chronic kidney disease. Am Soc Nephrol. 2007; 18: 1966-1977.
  25. Rabkin S.W. Arterial stiffness: detection and consequences in cognitive impairment and dementia of the elderly. J Alzheimers Dis 2012; 32(3): 541-549.
  26. Sander K., Bickel H., Förstl H. et al. Carotid-intima media thickness is independently associated with cognitive decline. The INVADE study. Int J Geriatr Psychiatry 2010; 25(4): 389-394.
  27. Atti A.R., Palmer K., Volpato S. et al. Anaemia increases the risk of dementia in cognitively intact elderly. 2006 Feb; 27(2): 278-284.
  28. Rabie T., Marti H.H. Brain protection by erythropoietin: a manifold task. Physiology (Bethesda) 2008; 23: 263-274.
  29. Pickett J.L., Theberge D.C., Brown W.S. et al. Normalizing hematocrit in dialysis patients improves brain function. Am. J. Kidney Dis.1999; 33: 1122-1130.
  30. Brines M.L., Ghezzi P., Keenan S. et al. Erythropoietin crosses the blood-brain barrier to protect against experimental brain injury. Proc. Natl Acad. Sci. 2000; 97; 10526-10531.
  31. Pfeffer M.A., Burdmann E.A., Chen C.Y. et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N. Engl. J. Med. 2009; 361: 2019-2032.
  32. Drueke T.B., Locatelli F., Clyne N. et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N. Engl. J. Med. 2006; 355: 2071-2084.
  33. Prins N.D., Den Heijer T., Hofman A. et al.; Rotterdam Scan Study. Homocysteine and cognitive function in the elderly: the Rotterdam Scan Study. Neurology 2002; 59: 1375-1380.
  34. Sachdev P. Homocysteine, cerebrovascular disease and brain atrophy. J Neurol Sci. 2004; 226: 25-29.
  35. Massy Z.A. Importance of homocysteine, lipoprotein(a) and non-classical cardiovascular risk factors (fibrinogen and advanced glycation end-products) for atherogenesis in uraemic patients. Nephrol Dial Transplant 2000; 15: 81-91.
  36. Seshadri S., Wolf P.A., Beiser A.S. et al. Association of plasma total homocysteine levels with subclinical brain injury: Cerebral volumes, white matter hyperintensity, and silent brain infarcts at volumetric magnetic resonance imaging in the Framingham Offspring Study. Arch Neurol 2008; 65: 642-649.
  37. Lipton S.A., Kim W.K., Choi Y.B. et al. Neurotoxicity associated with dual actions of homocysteine at the N-methyl-Daspartate receptor. Proc Natl Acad Sci 1997; 94: 5923-5928.
  38. Kwok T., Lee J., Law C.B. et al. A randomized placebo controlled trial of homocysteine lowering to reduce cognitive decline in older demented people. Clin Nutr 2011; 30: 297-302.
  39. Brady C.B., Gaziano J.M., Cxypoliski R.A. et al. Homocystein lowering and cohnition in CKD: the Veteran Affairs homocystein study. Am J Kidney Dis 2009; 54: 440-449.

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar

Este site utiliza cookies

Ao continuar usando nosso site, você concorda com o procedimento de cookies que mantêm o site funcionando normalmente.

Informação sobre cookies