Nutrition, cognition and chronic kidney disease: A comprehensive review of interactions and interventions

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2025-04-11 DOI:10.1111/eci.70045

Mehmet Kanbay, Lasin Ozbek, Mustafa Guldan, Sama Mahmoud Abdel-Rahman, Uluman Sisman, Francesca Mallamaci, Carmine Zoccali

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引用次数: 0

Abstract

Background

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.

Results and Discussion

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.

Conclusions

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.

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营养、认知和慢性肾脏疾病：相互作用和干预的综合综述

认知障碍是慢性肾脏疾病（CKD）的常见并发症，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。慢性肾病患者表现出记忆力、注意力、语言、视觉空间能力和执行功能的下降。结果与讨论尿毒症毒素、脑结构改变、血脑屏障功能障碍、贫血和糖尿病等合并症是导致糖尿病的因素。营养不良影响了近一半的慢性肾病患者，它通过炎症、氧化应激和蛋白质能量浪费加剧了认知能力下降。营养缺乏，尤其是蛋白质、维生素D、B族维生素、omega-3脂肪酸和抗氧化剂的缺乏，与认知能力受损有关。新出现的证据强调了肠-脑轴的作用，肠道来源的尿毒症毒素和微生物组改变有助于认知功能障碍。加工食品和微塑料通过促进炎症和神经毒性进一步加剧了风险。透析和肾移植为认知恢复提供了机会，尽管挑战仍然存在，特别是血液透析患者。营养干预措施，包括量身定制的蛋白质摄入、微量营养素补充和饮食咨询，对于减轻认知能力下降至关重要。通过有针对性的营养和药理学策略解决CKD合并症，如贫血和糖尿病，可以改善预后。考虑到慢性肾病患者焦虑和抑郁的高患病率，整合心理和社会支持可以提高生活质量。结论未来的研究应侧重于个性化营养、肠道菌群调节和常规认知评估，以优化护理。综合医疗、营养和社会心理策略的整体方法对于改善慢性肾病患者的认知和整体健康至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.