title: Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review.
abstract: OBJECTIVE
  The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions.
  
  
  METHODS
  Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis.
  
  
  RESULTS
  By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population.
  
  
  CONCLUSIONS
  Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544.
authors.affiliation: Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Shen
authors.affiliation: Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Qingwei
authors.initials: Q
authors.lastname: Ruan
authors.affiliation: Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Zhuowei
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China.
authors.forename: Zhongquan
authors.initials: Z
authors.lastname: Sun
mesh_terms: D006801:Humans; D060825:Cognitive Dysfunction / Q000453:epidemiology; D000073496:Frailty / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000523:psychology / Q000628:therapy
keywords: CKD; cognitive impairment; dementia; physical frailty; renal function