title: Neurological complications in chronic kidney disease patients.
abstract: Chronic kidney disease (CKD) is associated with a high prevalence of cerebrovascular disorders such as stroke, white matter diseases, intracerebral microbleeds and cognitive impairment. This situation has been observed not only in end-stage renal disease patients but also in patients with mild or moderate CKD. The occurrence of cerebrovascular disorders may be linked to the presence of traditional and non-traditional cardiovascular risk factors in CKD. Here, we review current knowledge on the epidemiological aspects of CKD-associated neurological and cognitive disorders and discuss putative causes and potential treatment. CKD is associated with traditional (hypertension, hypercholesterolaemia, diabetes etc.) and non-traditional cardiovascular risk factors such as elevated levels of oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anaemia and uraemic toxins. Clinical and animal studies indicate that these factors may modify the incidence and/or outcomes of stroke and are associated with white matter diseases and cognitive impairment. However, direct evidence in CKD patients is still lacking. A better understanding of the factors responsible for the elevated prevalence of cerebrovascular diseases in CKD patients may facilitate the development of novel treatments. Very few clinical trials have actually been performed in CKD patients, and the impact of certain treatments is subject to debate. Treatments that lower LDL cholesterol or blood pressure may reduce the incidence of cerebrovascular diseases in CKD patients, whereas treatment with erythropoiesis-stimulating agents may be associated with an increased risk of stroke but a decreased risk of cognitive disorders. The impact of therapeutic approaches that reduce levels of uraemic toxins has yet to be evaluated.
authors.affiliation: INSERM U1088, University of Picardie Jules Verne, Amiens, France Division of Pharmacology, Amiens University Hospital, Amiens, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chillon
authors.affiliation: Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France INSERM U1018, CESP, Team 5, Villejuif, France Versailles St-Quentin University-UVSQ, UMRS 1018, Montigny, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.affiliation: INSERM U1018, CESP, Team 5, Villejuif, France Versailles St-Quentin University-UVSQ, UMRS 1018, Montigny, France UMRS 1018, University of Paris-Sud, Villejuif, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
mesh_terms: D000818:Animals; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D019965:Neurocognitive Disorders / Q000209:etiology* / Q000517:prevention & control; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000473:pathology / Q000628:therapy; D012307:Risk Factors
keywords: cerebrovascular disease; chronic kidney disease; cognitive impairment; end-stage renal disease; epidemiology