Pathophysiology of cognitive impairment in chronic kidney disease.

IF 2.4 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI:10.1097/MNH.0000000000001117

Lino Merlino, James Tollitt, Ross A Dunne, Philip A Kalra

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Abstract

Purpose of review: Cognitive impairment (CI) is a frequent and disabling complication in individuals with chronic kidney disease (CKD). With rising CKD prevalence, especially in aging populations, there is a pressing need to understand the complex and multifactorial mechanisms linking kidney dysfunction to cognitive decline.

Recent findings: Emerging evidence highlights the multifactorial pathogenesis of CKD-related CI, involving vascular dysfunction, blood-brain barrier disruption, glymphatic impairment, systemic inflammation, uremic toxin accumulation, hormonal dysregulation, and gut-brain axis alterations. Additionally, mental health comorbidities, sarcopenia, sleep disorders, and renal replacement therapies further modulate cognitive outcomes. Advances in biomarker research and the identification of neuroprotective factors like Klotho may reshape diagnostic and therapeutic strategies.

Summary: CI in CKD results from a convergence of systemic and neural insults, modulated by resilience mechanisms and shaped by aging and comorbidities. Future research should explore interventions targeting modifiable contributors, such as vascular health, inflammation, and uremic toxicity, as well as enhancing neuroresilience to preserve cognitive function in this high-risk population.

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慢性肾病认知功能障碍的病理生理学研究。

综述目的：认知障碍（CI）是慢性肾脏疾病（CKD）患者中一种常见的致残性并发症。随着CKD患病率的上升，特别是在老龄化人群中，迫切需要了解肾功能障碍与认知能力下降之间复杂的多因素机制。最新发现：新出现的证据强调ckd相关CI的多因素发病机制，包括血管功能障碍、血脑屏障破坏、淋巴系统损伤、全身性炎症、尿毒症毒素积累、激素失调和肠-脑轴改变。此外，精神健康合并症、肌肉减少症、睡眠障碍和肾脏替代疗法进一步调节认知结果。生物标志物研究的进展和像Klotho这样的神经保护因子的鉴定可能会重塑诊断和治疗策略。总结：CKD的CI是系统和神经损伤的集合，受恢复机制调节，并受衰老和合并症的影响。未来的研究应该探索针对可改变因素的干预措施，如血管健康、炎症和尿毒症毒性，以及增强神经恢复力以保护这一高危人群的认知功能。

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

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.