1
|
Yuan Y, Chang J, Sun Q. Research Progress on Cognitive Frailty in Older Adults with Chronic Kidney Disease. Kidney Blood Press Res 2024; 49:302-309. [PMID: 38663363 DOI: 10.1159/000538689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND As the medical challenges posed by the ageing population become increasingly severe, the proportion of older people among patients with chronic kidney disease (CKD) is increasing every year. SUMMARY The prevalence of frailty in patients with CKD is significantly higher than that in the general population, and older patients are also a high-risk group for frailty and cognitive impairment. Cognitive frailty, as an important subtype of frailty, is a syndrome characterised by cognitive dysfunction caused by physiological factors, excluding Alzheimer's disease and other types of dementia. It is characterised by the coexistence of physical frailty and cognitive impairment. Previous studies have mainly focused on cognitive impairment, and there is limited research on cognitive frailty, particularly in older patients with CKD. KEY MESSAGES This article provides a comprehensive review of the concept, epidemiology, screening methods, prevention, and treatment measures and possible pathogenesis of cognitive frailty in patients with CKD.
Collapse
Affiliation(s)
- Yuqing Yuan
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qianmei Sun
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Gupta A, Mahnken JD, Bernal J, Sharma P, Lepping RJ, Montgomery RN, Johnson DK, Parks A, Burns JM, Drew DA, Sarnak MJ, Brooks WM. Changes in Cognitive Function After Kidney Transplantation: A Longitudinal Cohort Study. Am J Kidney Dis 2024:S0272-6386(24)00624-3. [PMID: 38423160 DOI: 10.1053/j.ajkd.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/11/2023] [Accepted: 12/23/2023] [Indexed: 03/02/2024]
Abstract
RATIONALE & OBJECTIVE Kidney disease negatively affects cognition. We assessed the effect of kidney transplantation (KT) on different cognitive domains. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS We examined pre- versus post-KT cognition in patients waitlisted for KT at an academic center. PREDICTORS Transplant status. We measured cognitive function before KT (n=101), 3 months after KT (n=78), and 1 year after KT (n = 83). OUTCOMES Our primary outcome was change in cognitive function before versus after KT. We used standard neuropsychological tests to assess global cognition (Mini-Mental State Exam [MMSE]), episodic/declarative memory (Logical Memory), psychomotor speed/visuospatial function (Digit Symbol Substitution Test [DSST], Trail Making Test [TMT] A), working memory/attention (Digit Span), executive function (TMT B), and semantic memory/verbal fluency/language (Category Fluency). ANALYTICAL APPROACH Using linear mixed model analysis, we evaluated the changes in neuropsychological test scores adjusted for age, sex, race, education, and number of assessments. RESULTS Before KT, Logical Memory I and II, DSST, MMSE, Category Fluency (animal naming), and Digit Span backward scores were low compared with normative values from the National Alzheimer's Coordinating Center data. Logical Memory I and II scores improved after KT (pre- vs post-KT, estimated group difference [d]=3.3, P<0.001 for Logical Memory I; d=4.27, P<0.001 for Logical Memory II), such that post-KT scores were similar to normative values (post-KT vs normative values, d = -0.37, P=0.06 for Logical Memory I; d = -0.89, P=0.08 for Logical Memory II). Category Fluency (animal naming; d=2.4, P<0.001) and DSST (d=3.12, P=0.01) scores also improved with KT, but post-KT DSST scores remained lower than normative values (post-KT vs normative values, d = -5.17, P<0.001). MMSE, Digit Span, and TMT A and B scores did not change after KT. LIMITATIONS Single-center study. CONCLUSIONS Episodic and verbal declarative memory normalize after KT. Semantic memory, verbal fluency, language, psychomotor speed, and visuospatial function show partial improvement. Cognitive impairment in kidney disease is therefore at least partly reversible with KT. PLAIN-LANGUAGE SUMMARY Cognitive impairment in kidney disease affects self-esteem, vocational abilities, quality of life, health care costs, and mortality. It is not clear whether kidney transplantation (KT) improves cognition and whether the improvement is uniform across cognitive domains. The distinction between reversible and irreversible cognitive impairment has important implications in the clinical care of patients before and after KT. We assessed cognition before KT and 3 months and 12 months after KT and discovered that episodic and verbal declarative memory normalized with KT. Semantic memory, verbal fluency, language, psychomotor speed, and visuospatial function also improved with KT but did not reach normal levels. Cognitive impairment in kidney disease is therefore at least partly reversible.
Collapse
Affiliation(s)
- Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Frontiers Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas.
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Frontiers Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas; Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Joshua Bernal
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Palash Sharma
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Rebecca J Lepping
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert N Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - David K Johnson
- Department of Neurology, University of California, Davis, Davis, California
| | - Adam Parks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas
| | - David A Drew
- Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Mark J Sarnak
- Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - William M Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Frontiers Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas; Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
3
|
Yu Z, Pang H, Yang Y, Luo D, Zheng H, Huang Z, Zhang M, Ren K. Microglia dysfunction drives disrupted hippocampal amplitude of low frequency after acute kidney injury. CNS Neurosci Ther 2024; 30:e14363. [PMID: 37469216 PMCID: PMC10848109 DOI: 10.1111/cns.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/21/2023] Open
Abstract
AIMS Acute kidney injury (AKI) has been associated with a variety of neurological problems, while the neurobiological mechanism remains unclear. In the present study, we utilized resting-state functional magnetic resonance imaging (rs-fMRI) to detect brain injury at an early stage and investigated the impact of microglia on the neuropathological mechanism of AKI. METHODS Rs-fMRI data were collected from AKI rats and the control group with a 9.4-Tesla scanner at 24, 48, and 72 h post administration of contrast medium or saline. The amplitude of low-frequency fluctuations (ALFF) was then compared across the groups at each time course. Additionally, flow cytometry and SMART-seq2 were employed to evaluate microglia. Furthermore, pathological staining and Western blot were used to analyze the samples. RESULTS MRI results revealed that AKI led to a decreased ALFF in the hippocampus, particularly in the 48 h and 72 h groups. Additionally, western blot suggested that AKI-induced the neuronal apoptosis at 48 h and 72 h. Flow cytometry and confocal microscopy images demonstrated that AKI activated the aggregation of microglia into neurons at 24 h, with a strong upregulation of M1 polarization at 48 h and peaking at 72 h, accompanying with the release of proinflammatory cytokines. The ALFF value was strongly correlated with the proportion of microglia (|r| > 0.80, p < 0.001). CONCLUSIONS Our study demonstrated that microglia aggregation and inflammatory factor upregulation are significant mechanisms of AKI-induced neuronal apoptosis. We used fMRI to detect the alterations in hippocampal function, which may provide a noninvasive method for the early detection of brain injury after AKI.
Collapse
Affiliation(s)
- Ziyang Yu
- School of MedicineXiamen UniversityXiamenChina
| | - Huize Pang
- Department of RadiologyThe First Hospital of China Medical UniversityShenyangChina
| | - Yifan Yang
- School of MedicineXiamen UniversityXiamenChina
| | - Doudou Luo
- School of MedicineXiamen UniversityXiamenChina
| | - Haiping Zheng
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life SciencesXiamen UniversityXiamenChina
| | - Zicheng Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public HealthXiamen UniversityXiamenChina
| | - Mingxia Zhang
- State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life SciencesXiamen UniversityXiamenChina
| | - Ke Ren
- School of MedicineXiamen UniversityXiamenChina
- Department of RadiologyThe First Hospital of China Medical UniversityShenyangChina
| |
Collapse
|
4
|
Lullmann O, van der Plas E, Harshman LA. Understanding the impact of pediatric kidney transplantation on cognition: A review of the literature. Pediatr Transplant 2023; 27:e14597. [PMID: 37664967 PMCID: PMC11034761 DOI: 10.1111/petr.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a relatively rare childhood disease that is associated with a wide array of medical comorbidities. Roughly half of all pediatric patients acquire CKD due to congenital anomalies of the kidneys and urinary tract, and of those with congenital disease, 50% will progress to end-stage kidney disease (ESKD) necessitating a kidney transplantation. The medical sequelae of advanced CKD/ESKD improve dramatically following successful kidney transplantation; however, the impact of kidney transplantation on neurocognition in children is less clear. It is generally thought that cognition improves following kidney transplantation; however, our knowledge on this topic is limited by the sparsity of high-quality data in the context of the relative rarity of pediatric CKD/ESKD. METHOD We conducted a narrative review to gauge the scope of the literature, using the PubMed database and the following keywords: cognition, kidney, brain, pediatric, neurocognition, intelligence, executive function, transplant, immunosuppression, and neuroimaging. RESULTS There are few published longitudinal studies, and existing work often includes wide heterogeneity in age at transplant, variable dialysis exposure/duration prior to transplant, and unaccounted cofounders which persist following transplantation, including socio-economic status. Furthermore, the impact of long-term maintenance immunosuppression on the brain and cognitive function of pediatric kidney transplant (KT) recipients remains unknown. CONCLUSION In this educational review, we highlight what is known on the topic of neurocognition and neuroimaging in the pediatric KT population.
Collapse
Affiliation(s)
- Olivia Lullmann
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
| | - Ellen van der Plas
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
- Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine; Little Rock, AR
| | - Lyndsay A. Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
| |
Collapse
|
5
|
Yu Z, Pang H, Liu Y, Li X, Bu S, Wang J, Zhao M, Ren K. Disrupted network communication predicts mild cognitive impairment in end-stage renal disease: an individualized machine learning study based on resting-state fMRI. Cereb Cortex 2023; 33:10098-10107. [PMID: 37492012 DOI: 10.1093/cercor/bhad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
End-Stage Renal Disease (ESRD) is known to be associated with a range of brain injuries, including cognitive decline. The purpose of this study is to investigate the functional connectivity (FC) of the resting-state networks (RSNs) through resting state functional magnetic resonance imaging (MRI), in order to gain insight into the neuropathological mechanism of ESRD. A total of 48 ESRD patients and 49 healthy controls underwent resting-state functional MRI and neuropsychological tests, for which Independent Components Analysis and graph-theory (GT) analysis were utilized. With the machine learning results, we examined the connections between RSNs abnormalities and neuropsychological test scores. Combining intra/inter network FC differences and GT results, ESRD was optimally distinguished in the testing dataset, with a balanced accuracy of 0.917 and area under curve (AUC) of 0.942. Shapley additive explanations results revealed that the increased functional network connectivity between DMN and left frontoparietal network (LFPN) was the most critical predictor for ESRD associated mild cognitive impairment diagnosis. Moreover, hypoSN (salience network) was positively correlated with Attention scores, while hyperLFPN was negatively correlated with Execution scores, indicating correlations between functional disruption and cognitive impairment measurements in ESRD patients. This study demonstrated that both the loss of FC within the SN and compensatory FC within the lateral frontoparietal network coexist in ESRD. This provides a network basis for understanding the individual brain circuits and offers additional noninvasive evidence to comprehend the brain networks in ESRD.
Collapse
Affiliation(s)
- Ziyang Yu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Huize Pang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yu Liu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaolu Li
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuting Bu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Juzhou Wang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Mengwan Zhao
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ke Ren
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
6
|
Gupta A, Bansal A, Young K, Gautam A, Donald J, Comfort B, Montgomery R. Blood-Brain Barrier Permeability in ESKD-A Proof-of-Concept Study. J Am Soc Nephrol 2023; 34:1508-1511. [PMID: 37400109 PMCID: PMC10482059 DOI: 10.1681/asn.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Aditi Gupta
- Division of Nephrology and Hypertension and the Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas
- Department of Internal Medicine, University of Kansas Alzheimer's Disease Research Center, Kansas City, Kansas
- Department of Neurology, University of Kansas Alzheimer's Disease Research Center, Kansas City, Kansas
| | - Aanya Bansal
- Department of Internal Medicine, University of Kansas Alzheimer's Disease Research Center, Kansas City, Kansas
| | - Kate Young
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Archana Gautam
- Department of Internal Medicine, University of Kansas Alzheimer's Disease Research Center, Kansas City, Kansas
| | - Joseph Donald
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Branden Comfort
- Department of Internal Medicine, University of Kansas Alzheimer's Disease Research Center, Kansas City, Kansas
| | - Robert Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
7
|
Mahaparn I, Lepping RJ, Montgomery RN, Mukherjee R, Billinger SA, Brooks WM, Gupta A. The Association of Tacrolimus Formulation on Cerebral Blood Flow and Cognitive Function. Transplant Direct 2023; 9:e1511. [PMID: 37456588 PMCID: PMC10348734 DOI: 10.1097/txd.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/18/2023] Open
Abstract
Calcineurin inhibitors are inherent vasoconstrictors. Cerebral vasoconstriction can reduce cerebral blood flow (CBF), and negatively impact cerebrovascular response (CVR) to exercise, and cognitive function. The once-daily extended-release (LCP) tacrolimus has fewer side effects than the immediate-release (IR) tacrolimus. The role of calcineurin inhibitors on CBF and the impact of specific formulations of tacrolimus on CBF, CVR, and cognitive function are unknown. In this pilot study, we evaluated whether changing from IR tacrolimus to LCP tacrolimus modulates CBF, CVR, or cognitive function in kidney transplant (KT) recipients. Methods We randomized (2:1) 30 stable KT recipients on IR tacrolimus to intervention (switch to LCP tacrolimus) and control (continue IR tacrolimus) arms. We measured CBF, CVR, and cognitive function at baseline and at 12 wk. We used ANCOVA to evaluate changes in outcome variables, with baseline values and study arm as covariates. We used descriptive statistics with mean changes in outcome variables to compare the 2 groups. Results Participants were 51 ± 13 y old. There was no difference in plasma tacrolimus levels at baseline and at 12 wk in the 2 arms. The changes in CBF, resting middle cerebral artery velocity, CVR, and cognitive function were more favorable in the intervention arm than in the control group. Conclusions Changing IR tacrolimus to LCP tacrolimus may improve CBF, cerebrovascular dynamics, and cognitive function in KT recipients. Larger studies are needed to confirm these results.
Collapse
Affiliation(s)
- Irisa Mahaparn
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Rebecca J. Lepping
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
| | - Robert N. Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS
| | - Rishav Mukherjee
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS
| | - Sandra A. Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - William M. Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
| | - Aditi Gupta
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
8
|
Zhang C, Yu H, Cai Y, Wu N, Liang S, Zhang C, Duan Z, Zhang Z, Cai G. Diffusion tensor imaging of the brain white matter microstructure in patients with chronic kidney disease and its correlation with cognition. Front Neurol 2022; 13:1086772. [PMID: 36588888 PMCID: PMC9798235 DOI: 10.3389/fneur.2022.1086772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose In individuals with chronic kidney disease (CKD), neurological damage is commonly observed. This neurodegeneration is closely linked to microstructural damage to the brain white matter due to the high incidence of cognitive dysfunction. However, the specific pathogenesis of CKD nephropathy caused by cognitive system developmental disorders remains unclear. This study aimed to examine the correlation between cognitive impairment and diffusion parameters obtained on diffusion tensor imaging (DTI) of abnormal white matter tracts in CKD patients. Methods Sixty-four patients with CKD were divided into the non-dialysis-dependent CKD (NDD-CKD) group (N = 26) and dialysis-dependent CKD (DD-CKD) group (N = 38) according to the estimated glomerular filtration rate, whereas 43 healthy control subjects (normal control [NC]) were included and underwent cranial magnetic resonance imaging during the same period. Differences in the abnormal white matter microstructure and correlations between them and cognitive scores were assessed using several parameters between the groups. Results There were more extensive peri-lesions and distant white matter microstructural changes in the DD-CKD and NDD-CKD groups than in the NC group. DTI diffusion parameters in abnormal white matter regions were associated with impaired cognitive function in CKD patients. The DD-CKD group had worse cognitive function and more severe microstructural damage in the cerebral white matter than the NDD-CKD group. Conclusion CKD patients showed cognitive impairment and changes in the brain white matter microstructure; CKD can lead to extensive white matter tract damage. Additionally, diffusion parameters can be used as a complement to describe structural brain damage in CKD patients.
Collapse
Affiliation(s)
- Chaoyang Zhang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Huan Yu
- Department of Radiology, Liangxiang Hospital, Beijing, China
| | - Yan Cai
- Department of Nephrology, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Ning Wu
- Department of Medical Imaging, Yanjing Medical College, Capital Medical University, Beijing, China
| | - Shuang Liang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Chun Zhang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Zhiyu Duan
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Zhou Zhang
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, General Hospital of the Chinese People's Liberation Army, Beijing, China,*Correspondence: Guangyan Cai
| |
Collapse
|
9
|
Chu NM, Bae S, Chen X, Ruck J, Gross AL, Albert M, Neufeld KJ, Segev DL, McAdams-DeMarco MA. Delirium, changes in cognitive function, and risk of diagnosed dementia after kidney transplantation. Am J Transplant 2022; 22:2892-2902. [PMID: 35980673 PMCID: PMC10138281 DOI: 10.1111/ajt.17176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/25/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023]
Abstract
Kidney transplant (KT) recipients with delirium, a preventable surgical complication, are likely to reap cognitive benefits from restored kidney function, but may be more vulnerable to longer-term neurotoxic stressors post-KT (i.e., aging, immunosuppression). In this prospective cohort study, we measured delirium (chart-based), global cognitive function (3MS), and executive function (Trail Making Test Part B minus Part A) in 894 recipients (2009-2021) at KT, 1/3/6-months, 1-year, and annually post-KT. Dementia was ascertained using linked Medicare claims. We described repeated measures of cognitive performance (mixed effects model) and quantified dementia risk (Fine & Gray competing risk) by post-KT delirium. Of 894 recipients, 43(4.8%) had post-KT delirium. Delirium was not associated with global cognitive function at KT (difference = -3.2 points, 95%CI: -6.7, 0.4) or trajectories post-KT (0.03 points/month, 95%CI: -0.27, 0.33). Delirium was associated with worse executive function at KT (55.1 s, 95%CI: 25.6, 84.5), greater improvements in executive function <2 years post-KT (-2.73 s/month, 95%CI: -4.46,-0.99), and greater decline in executive function >2 years post-KT (1.72 s/month, 95%CI: 0.22, 3.21). Post-KT delirium was associated with over 7-fold greater risk of dementia post-KT (adjusted subdistribution hazard ratio = 7.84, 95%CI: 1.22, 50.40). Transplant centers should be aware of cognitive risks associated with post-KT delirium and implement available preventative interventions to reduce delirium risk.
Collapse
Affiliation(s)
- Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sunjae Bae
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Karin J. Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara A. McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
10
|
Meeusen JW, Stämmler F, Dasari S, Schiffer E, Lieske JC. Serum myo-inositol and valine improve metabolomic-based estimated glomerular filtration rate among kidney transplant recipients. Front Med (Lausanne) 2022; 9:988989. [PMID: 36465899 PMCID: PMC9712186 DOI: 10.3389/fmed.2022.988989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/31/2022] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Close monitoring of glomerular filtration rate (GFR) is essential for the management of patients post kidney transplantation. Measured GFR (mGFR), the gold standard, is not readily accessible in most centers. Furthermore, the performance of new estimated GFR (eGFR) equations based upon creatinine and/or cystatin C have not been validated in kidney transplant patients. Here we evaluate a recently published eGFR equation using cystatin C, creatinine, myo-inositol and valine as measured by nuclear magnetic resonance (eGFRNMR). METHODS Residual sera was obtained from a cohort of patients with clinically ordered iothalamate renal clearance mGFR (n = 602). Kidney transplant recipients accounted for 220 (37%) of participants. RESULTS Compared to mGFR, there was no significant bias for eGFRcr or eGFRNMR, while eGFRcr-cys significantly underestimated mGFR. P30 values were similar for all eGFR. P15 was significantly higher for eGFRNMR compared to eGFRcr, while the P15 for eGFRcr-cys only improved among patients without a kidney transplant. Agreement with mGFR CKD stages of <15, 30, 45, 60, and 90 ml/min/1.73 m2 was identical for eGFRcr and eGFRcr-cys (61.8%, both cases) while eGFRNMR was significantly higher (66.4%) among patients with a kidney transplant. CONCLUSION The 2021 CKD-EPI eGFRcr and eGFRcr-cys have similar bias, P15, and agreement while eGFRNMR more closely matched mGFR with the strongest improvement among kidney transplant recipients.
Collapse
Affiliation(s)
- Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Frank Stämmler
- Department of Research and Development, numares AG, Regensburg, Germany
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, United States
| | - Eric Schiffer
- Department of Research and Development, numares AG, Regensburg, Germany
| | - John C. Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
11
|
Binari LA, Kiehl AL, Jackson JC, Feurer ID, Rega SA, Altuhaifi TM, Yankyera RP, Reed M, Sika M, Van J, Collar EM, Forbes RC, Concepcion BP. Neurocognitive Function Changes Following Kidney Transplant: A Prospective Study. Kidney Med 2022; 4:100560. [PMID: 36507052 PMCID: PMC9732409 DOI: 10.1016/j.xkme.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Rationale & Objective Patients with advanced kidney disease are at risk for cognitive impairment, which may persist after kidney transplantation. We sought to understand changes in neurocognitive function domains utilizing comprehensive cognitive assessments. Study Design Prospective cohort study. Setting & Population Single-center study of patients undergoing kidney transplantation. Exposure Kidney transplantation. Outcomes Changes in neurocognitive function as measured by the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Trail Making Test Parts A and B (TRAIL A and B) before transplantation (baseline) and compared to 3 months and 12 months posttransplant. Analytical Approach Wilcoxon signed-rank and linear mixed effect models were utilized to assess changes in neurocognitive scores at 3 months and 12 months compared to baseline. Results Thirty-two patients were included with a mean age of 45 years, 47% female, 85% White, and 62% with at least some college education. Hypertension and diabetes were etiologies of kidney disease in 31% and 25% of patients, respectively. Baseline RBANS and TRAIL A and B scores averaged 84.7 ± 14, 40.4 ± 9.9, and 41 ± 11.5, respectively. Although there were posttransplant improvements in immediate and delayed memory at 3 months, these were not sustained at 12 months. There were no significant differences from baseline at 3 months and 12 months in RBANS index scores for language, visuospatial/constructional abilities, and attention. Compared to baseline, TRAIL A scores were not significantly different at 3 months but were significantly improved at 12 months, whereas TRAIL B scores improved significantly at both 3 months and 12 months. Limitations Single-center design and small sample size. Conclusions Utilizing comprehensive cognitive assessments, we found improvements in attention and executive function in the first posttransplant year as measured by TRAIL A and B. However, there was no significant change in global cognition as measured by RBANS. These findings identify cognitive domains for potential intervention in the posttransplant population.
Collapse
Affiliation(s)
- Laura A. Binari
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Amy L. Kiehl
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Veteran’s Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - James C. Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Veteran’s Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - Irene D. Feurer
- Department of Surgery, Department of Biostatistics, Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Scott A. Rega
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Tareq M. Altuhaifi
- Nephrology Clinical Trials Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Rita P. Yankyera
- Nephrology Clinical Trials Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Malia Reed
- Nephrology Clinical Trials Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Mohammed Sika
- Nephrology Clinical Trials Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Julie Van
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Psychology, Neuroscience Center, Brigham Young University, Provo, UT
| | - Erin M. Collar
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Veteran’s Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - Rachel C. Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Beatrice P. Concepcion
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Address for Correspondence: Beatrice P. Concepcion, MD, MS, 1313 21st Avenue S, Oxford House 912F, Nashville, TN 37232.
| |
Collapse
|
12
|
Gupta A, Montgomery RN, Mukherjee R, Chakraborty S, Thomas TS, Cibrik DM, Drew D, Sarnak M. Pre-transplant cognitive screening is a poor predictor of post-transplant cognitive status. Clin Transplant 2022; 36:e14798. [PMID: 35989467 PMCID: PMC10691449 DOI: 10.1111/ctr.14798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/30/2022] [Accepted: 08/15/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Transplant centers hesitate to transplant patients with cognitive impairment. It is unclear if pre-kidney transplant (KT) cognitive screening can predict post-KT cognitive function. METHODS We evaluated pre- to post-KT cognitive function with the Montreal Cognitive Assessment (MoCA) in a cohort of 108 patients. We used an adjusted logistic regression model to assess pre- to post-KT changes in cognitive status (continuous variable) and a linear mixed model to assess changes in MoCA scores (categorical variable) pre- to post- KT. RESULTS The average pre- and post-KT MoCA scores were 25.3 ± 3.0 and 26.4 ± 2.8, respectively. Final pre-KT score did not predict post-KT cognitive status (OR = 1.08; 95% CI: .92-1.26; P = .35). 32% of the patients with a final pre-KT score ≥26 had at least one post-KT score < 26. Conversely, 61% of the patients with a final pre-KT score < 26 had at least one post KT score ≥26. In the linear mixed model analysis, the final pre-KT score was associated with a small, clinically insignificant (β = .34; 95% CI: .19-.49; P < .001) effect on the post-KT score. CONCLUSION A low pre-KT MoCA score is not a strong independent predictor of post-KT cognitive function and should not preclude patients from receiving a KT.
Collapse
Affiliation(s)
- Aditi Gupta
- Center for Transplantation, University of Kansas Medical Center, Kansas City
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City
- KU Alzheimer’s Disease Research Center, University of Kansas Medical Center, Kansas City
| | - Robert N. Montgomery
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City
| | - Rishav Mukherjee
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City
| | - Shweta Chakraborty
- Center for Transplantation, University of Kansas Medical Center, Kansas City
| | - Tashra S. Thomas
- Center for Transplantation, University of Kansas Medical Center, Kansas City
| | - Diane M. Cibrik
- Center for Transplantation, University of Kansas Medical Center, Kansas City
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City
| | - David Drew
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Mark Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA
| |
Collapse
|
13
|
Cognitive Function Prekidney Transplantation to Postkidney Transplantation: Putting Current Data into Clinical Perspective. Kidney Med 2022; 4:100566. [DOI: 10.1016/j.xkme.2022.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
14
|
Tariq H, Ramakrishnan M, Gupta A. Insights into Cognitive Brain Health in Chronic Kidney Disease. GERONTOLOGY & GERIATRICS : RESEARCH 2022; 8:1074. [PMID: 37671071 PMCID: PMC10478617 DOI: 10.26420/gerontolgeriatrres.2022.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Cognitive impairment and Chronic Kidney Disease (CKD) are common in older adults. With advances in medicine, the average lifespan is expected to increase, further increasing the prevalence of both conditions. The mechanisms underlying cognitive impairment in CKD are unclear. While mild-moderately low estimated glomerular filtration rate (eGFR) may not be associated with cognitive impairment, severely decreased eGFR and albuminuria do. Patients on dialysis have a high prevalence of cognitive impairment. Cognitive function improves after kidney transplantation. However, some residual cognitive deficits persist after transplantation, indicating that restoring the kidney function alone may not be enough to restore cognitive function, and other etiological factors may play a role. Albuminuria, another marker of CKD is also associated with cognitive impairment. However, albuminuria is often undiagnosed. Improving early identification and management of patients with albuminuria may be a good population-based dementia prevention strategy. Other factors associated with cognitive impairment in CKD include anemia and other metabolic derangements commonly observed in CKD. In this article, we reviewed the prevalence of cognitive impairment in CKD, the potential mechanisms underlying cognitive impairment in CKD, andthecurrent evidence on the association between cognitive impairment and eGFR and albuminuria.
Collapse
Affiliation(s)
- H Tariq
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - M Ramakrishnan
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - A Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| |
Collapse
|
15
|
Grasing M, Kennedy K, Sarnak MJ, Burns JM, Gupta A. Mild to moderate decrease in eGFR and cognitive decline in older adults. Nephrol Dial Transplant 2022; 37:1499-1506. [PMID: 34289074 PMCID: PMC9317170 DOI: 10.1093/ndt/gfab226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whether mild to moderately low estimated glomerular filtration rate (eGFR) is associated with cognitive decline in older adults is not clear. We evaluated changes in cognition in relation to baseline eGFR in older adults participating in the Alzheimer's Disease Neuroimaging Initiative (ADNI). METHODS This is a longitudinal secondary analysis of an established observational cohort. We used data from the ADNI, an National Institutes of Health-funded, multicenter longitudinal observational study that includes participants with and without cognitive impairment who were administered a comprehensive battery of neuropsychological tests every 6 months. We related the Chronic Kidney Disease Epidemiology Collaboration eGFR with previously validated cognition composite scores for memory (ADNI-Mem) and executive function (ADNI-EF) in multivariable linear regression analysis adjusted for age, sex, race and level of education. RESULTS A total of 1127 ADNI participants (mean age 74 ± 7 years, 57% men, 97% Caucasian, mean follow-up 6 ± 2.6 years) were included in the analysis. The mean baseline eGFR was 76 ± 19 mL/min/1.73 m2, with 6% with eGFR <45, 22% with eGFR 45-<60, 51% with eGFR 60-90 and 21% with eGFR >90 mL/min/1.73 m2 at baseline. Both ADNI-Mem and ADNI-EF scores declined over time. In the multivariable linear regression model, older age (β = -0.117, P = 0.01), female sex (β = 0.312, P < 0.001) and lower education (β = 0.079, P < 0.001) were associated with a decline in ADNI-Mem scores, whereas baseline eGFR (each 10 mL/min/1.73 m2 change) was not {β = -0.03 [confidence interval (CI) -0.06-0.001], P = 0.11}. Similarly, older age (β = -0.278, P < 0.001) and lower education (β = 0.099, P < 0.001) were associated with a decline in ADNI-EF scores, whereas baseline eGFR was not [β = 0.004 (95% CI -0.04-0.04), P = 0.84]. CONCLUSIONS In this cohort from the ADNI study, there was no association between baseline eGFR and cognitive decline in older adults with mild to moderately low eGFR.
Collapse
Affiliation(s)
- Michael Grasing
- University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Mark J Sarnak
- Division of Nephrology and Hypertension, Tufts Medical Center, Boston, MA, USA
| | - Jeffrey M Burns
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
16
|
Kurella Tamura M, Gaussoin S, Pajewski NM, Zaharchuk G, Freedman BI, Rapp SR, Auchus AP, Haley WE, Oparil S, Kendrick J, Roumie CL, Beddhu S, Cheung AK, Williamson JD, Detre JA, Dolui S, Bryan RN, Nasrallah IM. Kidney Disease, Hypertension Treatment, and Cerebral Perfusion and Structure. Am J Kidney Dis 2022; 79:677-687.e1. [PMID: 34543687 PMCID: PMC8926938 DOI: 10.1053/j.ajkd.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in individuals with and without CKD. STUDY DESIGN Neuroimaging substudy of a randomized trial. SETTING & PARTICIPANTS A subset of participants in the Systolic Blood Pressure Intervention Trial (SPRINT) who underwent brain magnetic resonance imaging studies. Presence of baseline CKD was assessed by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). INTERVENTION Participants were randomly assigned to intensive (systolic BP <120 mm Hg) versus standard (systolic BP <140 mm Hg) BP lowering. OUTCOMES The magnetic resonance imaging outcome measures were the 4-year change in global cerebral blood flow (CBF), white matter lesion (WML) volume, and total brain volume (TBV). RESULTS A total of 716 randomized participants with a mean age of 68 years were enrolled; follow-up imaging occurred after a median 3.9 years. Among participants with eGFR <60 mL/min/1.73 m2 (n = 234), the effects of intensive versus standard BP treatment on change in global CBF, WMLs, and TBV were 3.38 (95% CI, 0.32 to 6.44) mL/100 g/min, -0.06 (95% CI, -0.16 to 0.04) cm3 (inverse hyperbolic sine-transformed), and -3.8 (95% CI, -8.3 to 0.7) cm3, respectively. Among participants with UACR >30 mg/g (n = 151), the effects of intensive versus standard BP treatment on change in global CBF, WMLs, and TBV were 1.91 (95% CI, -3.01 to 6.82) mL/100 g/min, 0.003 (95% CI, -0.13 to 0.13) cm3 (inverse hyperbolic sine-transformed), and -7.0 (95% CI, -13.3 to -0.3) cm3, respectively. The overall treatment effects on CBF and TBV were not modified by baseline eGFR or UACR; however, the effect on WMLs was attenuated in participants with albuminuria (P = 0.04 for interaction). LIMITATIONS Measurement variability due to multisite design. CONCLUSIONS Among adults with hypertension who have primarily early kidney disease, intensive versus standard BP treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive BP treatment targets on brain health in persons with early kidney disease. FUNDING SPRINT was funded by the National Institutes of Health (including the National Heart, Lung, and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute on Aging; and the National Institute of Neurological Disorders and Stroke), and this substudy was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases. TRIAL REGISTRATION SPRINT was registered at ClinicalTrials.gov with study number NCT01206062.
Collapse
Affiliation(s)
- Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA.
| | - Sarah Gaussoin
- Departments of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas M Pajewski
- Departments of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Greg Zaharchuk
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen R Rapp
- Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alexander P Auchus
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS
| | - William E Haley
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Kendrick
- Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Christianne L Roumie
- VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Srinivasan Beddhu
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah and Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT
| | - Alfred K Cheung
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah and Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT
| | - Jeff D Williamson
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - John A Detre
- Departments of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sudipto Dolui
- Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - R Nick Bryan
- Department of Diagnostic Medicine Dell Medical School, University of Texas Austin Austin, TX
| | - Ilya M Nasrallah
- Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
17
|
Steinbach EJ, Harshman LA. Impact of Chronic Kidney Disease on Brain Structure and Function. Front Neurol 2022; 13:797503. [PMID: 35280279 PMCID: PMC8913932 DOI: 10.3389/fneur.2022.797503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
Chronic kidney disease (CKD) affects more than 37 million American adults. Adult-onset CKD is typically attributed to acquired comorbidities such as aging, type II diabetes, and cardiovascular disease. Conversely, congenital abnormalities of the kidney and urinary tract are the most common cause of CKD in children. Both adult and pediatric patients with CKD are at risk for neurocognitive dysfunction, particularly in the domain of executive function. The exact mechanism for neurocognitive dysfunction in CKD is not known; however, it is conceivable that the multisystemic effects of CKD—including hypertension, acidosis, anemia, proteinuria, and uremic milieu—exert a detrimental effect on the brain. Quantitative neuroimaging modalities, such as magnetic resonance imaging (MRI), provide a non-invasive way to understand the neurobiological underpinnings of cognitive dysfunction in CKD. Adult patients with CKD show differences in brain structure; however, much less is known about the impact of CKD on neurodevelopment in pediatric patients. Herein, this review will summarize current evidence of the impact of CKD on brain structure and function and will identify the critical areas for future research that are needed to better understand the modifiable risk factors for abnormal brain structure and function across both pediatric and adult CKD populations.
Collapse
Affiliation(s)
- Emily J. Steinbach
- Department of Radiation Oncology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Lyndsay A. Harshman
- Division of Nephrology, Dialysis, and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States
- *Correspondence: Lyndsay A. Harshman
| |
Collapse
|
18
|
Gu W, He R, Su H, Ren Z, Zhang L, Yuan H, Zhang M, Ma S. Changes in the Shape and Volume of Subcortical Structures in Patients With End-Stage Renal Disease. Front Hum Neurosci 2022; 15:778807. [PMID: 34975435 PMCID: PMC8716492 DOI: 10.3389/fnhum.2021.778807] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: End-stage renal disease (ESRD) typically causes changes in brain structure, and patients with ESRD often experience cognitive and sleep disorders. We aimed to assess the changes in the subcortical structure of patients with ESRD and how they are associated with cognitive and sleep disorders. Methods: We involved 36 adult patients for maintenance hemodialysis and 35 age- and gender-matched control individuals. All participants underwent neuropsychological examination and 3T magnetic resonance imaging (MRI) to acquire T1 anatomical images. The laboratory blood tests were performed in all patients with ESRD close to the time of the MR examination. We used volumetric and vertex-wise shape analysis approaches to investigate the volumes of 14 subcortical structural (e.g., bilateral accumbens, amygdala, hippocampus, caudate, globus pallidus, putamen, and thalamus) abnormalities in the two groups. Analyses of partial correlations and shape correlations were performed in order to identify the associations between subcortical structure, cognition, and sleep quality in patients with ESRD. Results: The volumetric analysis showed that compared with the healthy control group, patients with ESRD had less bilateral thalamus (left: p < 0.001; right: p < 0.001), bilateral accumbens (left: p < 0.001; right: p = 0.001), and right amygdala (p = 0.002) volumes. In the vertex-wise shape analysis, patients with ESRD had abnormal regional surface atrophy in the bilateral thalamus, right accumbens, left putamen, and bilateral caudate. Moreover, the Montreal Cognitive Assessment (MoCA) score was associated with volume reduction in the bilateral thalamus (left: Spearman ρ = 0.427, p = 0.009; right: ρ = 0.319, p = 0.018), and the Pittsburgh Sleep Quality Index (PSQI) score was associated with volume reduction in the bilateral accumbens (left: ρ = −0.546, p = 0.001; right: ρ = −0.544, p = 0.001). In vertex-wise shape correlation analysis, there was a positive significant correlation between regional shape deformations on the bilateral thalamus and MoCA score in patients with ESRD. Conclusion: Our study suggested that patients with ESRD have subcortical structural atrophy, which is related to impaired cognitive performance and sleep disturbances. These findings may help to further understand the underlying neural mechanisms of brain changes in patients with ESRD.
Collapse
Affiliation(s)
- Wen Gu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ronghua He
- Department of Radiology, Baoji Center Hospital, Baoji, China
| | - Hang Su
- Department of Radiology, Baoji Center Hospital, Baoji, China
| | - Zhuanqin Ren
- Department of Radiology, Baoji Center Hospital, Baoji, China
| | - Lei Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Radiology, Baoji High-Tech Hospital, Baoji, China
| | - Huijie Yuan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shaohui Ma
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
19
|
Ward JL, Ramakrishnan M, Jurgensen A, Billinger S, Gupta A. Cerebrovascular Response during Acute Exercise in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2022; 17:111-113. [PMID: 34615658 PMCID: PMC8763154 DOI: 10.2215/cjn.08410621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Jaimie L. Ward
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Madhuri Ramakrishnan
- Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew Jurgensen
- Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas
| | - Sandra Billinger
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Aditi Gupta
- Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
20
|
Crowe K, Quinn TJ, Mark PB, Findlay MD. "Is It Removed During Dialysis?"-Cognitive Dysfunction in Advanced Kidney Failure-A Review Article. Front Neurol 2021; 12:787370. [PMID: 34925220 PMCID: PMC8674209 DOI: 10.3389/fneur.2021.787370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Cognitive impairment is independently associated with kidney disease and increases in prevalence with declining kidney function. At the stage where kidney replacement therapy is required, with dialysis or transplantation, cognitive impairment is up to three times more common, and can present at a younger age. This is not a new phenomenon. The cognitive interactions of kidney disease are long recognized from historical accounts of uremic encephalopathy and so-called "dialysis dementia" to the more recent recognition of cognitive impairment in those undergoing kidney replacement therapy (KRT). The understanding of cognitive impairment as an extra-renal complication of kidney failure and effect of its treatments is a rapidly developing area of renal medicine. Multiple proposed mechanisms contribute to this burden. Advanced vascular aging, significant multi-morbidity, mood disorders, and sleep dysregulation are common in addition to the disease-specific effects of uremic toxins, chronic inflammation, and the effect of dialysis itself. The impact of cognitive impairment on people living with kidney disease is vast ranging from increased hospitalization and mortality to decreased quality of life and altered decision making. Assessment of cognition in patients attending for renal care could have benefits. However, in the context of a busy clinical service, a pragmatic approach to assessing cognitive function is necessary and requires consideration of the purpose of testing and resources available. Limited evidence exists to support treatments to mitigate the degree of cognitive impairment observed, but promising interventions include physical or cognitive exercise, alteration to the dialysis treatment and kidney transplantation. In this review we present the history of cognitive impairment in those with kidney failure, and the current understanding of the mechanisms, effects, and implications of impaired cognition. We provide a practical approach to clinical assessment and discuss evidence-supported treatments and future directions in this ever-expanding area which is pivotal to our patients' quality and quantity of life.
Collapse
Affiliation(s)
- Kirsty Crowe
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Patrick B. Mark
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mark D. Findlay
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| |
Collapse
|
21
|
Abstract
Uremic encephalopathy encompasses a wide range of central nervous system abnormalities associated with poor kidney function occurring with either progressive chronic kidney disease or acute kidney injury. The syndrome is likely caused by retention of uremic solutes, alterations in hormonal metabolism, changes in electrolyte and acid-base homeostasis, as well as changes in vascular reactivity, blood-brain barrier transport, and inflammation. There are no defining clinical, laboratory, or imaging findings, and the diagnosis is often made retrospectively when symptoms improve after dialysis or transplantation. The diagnosis is also made difficult because of the many confounding and overlapping conditions seen in patients with chronic kidney disease and acute kidney injury. Thus, institution of kidney replacement therapy should be considered as a trial to improve symptoms in the right clinical context. Neurological symptoms that do not improve after improvement in clearance should prompt a search for other explanations. Further knowledge linking possible uremic retention solutes with neurological symptoms is needed to better understand this syndrome as well as to develop more tailored treatments that aim to improve cognitive function.
Collapse
|