title: Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy.
abstract: Chronic kidney disease (CKD) is a highly prevalent condition in the world. Neurological, psychological, and cognitive disorders, related to CKD, could contribute to the morbidity, mortality, and poor quality of life of these patients. The aim of this study was to assess the neurological, psychological, and cognitive imbalance in patients with CKD on conservative and replacement therapy.Seventy-four clinically stable patients affected by CKD on conservative therapy, replacement therapy (hemodialysis (HD), peritoneal dialysis (PD)), or with kidney transplantation (KT) and 25 healthy controls (HC), matched for age and sex were enrolled. Clinical, laboratory, and instrumental examinations, as renal function, inflammation and mineral metabolism indexes, electroencephalogram (EEG), psychological (MMPI-2, Sat P), and cognitive tests (neuropsychological tests, NPZ5) were carried out.The results showed a significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (P = 0.008, P < 0.001, P = 0.051), a positive correlation between relative power of delta band and C-reactive protein (CRP) (P < 0.001) and a negative correlation between estimated glomerular filtration rate (eGFR) (P < 0.001) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) (P < 0.001), in all the samples. Qualitative analysis of EEG showed alterations of Grade 2 (according to Parsons-Smith classification) in patients on conservative therapy, and Grade 2-3 in KT patients. The scales of MMPI-2 hysteria and paranoia, are significantly correlated with creatinine, eGFR, serum nitrogen, CRP, 1,25-(OH)2D3, intact parathyroid hormone (iPTH), phosphorus, and cynical and hysterical personality, are correlated with higher relative power of delta (P = 0.016) and theta band (P = 0.016). Moreover, all NPZ5 scores showed a significant difference between the means of nephropathic patients and the means of the HC, and a positive correlation with eGFR, serum nitrogen, CRP, iPTH, and vitamin D.In CKD patients, simple and noninvasive instruments, as EEG, and cognitive-psychological tests, should be performed and careful and constant monitoring of renal risk factors, probably involved in neuropsychological complications (inflammation, disorders of mineral metabolism, electrolyte disorders, etc.), should be carried out. Early identification and adequate therapy of neuropsychological, and cognitive disorders, might enable a better quality of life and a major compliance with a probable reduction in the healthcare costs.
authors.affiliation: Department of Clinical Medicine Department of Neurology and Psychiatry Department of General and Specialised Surgery "PARIDE STEFANINI" Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Sapienza University of Rome Department of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, A. Gemelli, Rome Department of Clinical and Experimental Sciences, University of Brescia, Brescia Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lai
authors.forename: Oriano
authors.initials: O
authors.lastname: Mecarelli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pulitano
authors.forename: Roberto
authors.initials: R
authors.lastname: Romanello
authors.forename: Leonardo
authors.initials: L
authors.lastname: Davi
authors.forename: Alessia
authors.initials: A
authors.lastname: Zarabla
authors.forename: Amalia
authors.initials: A
authors.lastname: Mariotti
authors.forename: Maria
authors.initials: M
authors.lastname: Carta
authors.forename: Giorgia
authors.initials: G
authors.lastname: Tasso
authors.forename: Luca
authors.initials: L
authors.lastname: Poli
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Mitterhofer
authors.forename: Massimo
authors.initials: M
authors.lastname: Testorio
authors.forename: Nicla
authors.initials: N
authors.lastname: Frassetti
authors.forename: Paola
authors.initials: P
authors.lastname: Aceto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Galani
authors.forename: Carlo
authors.initials: C
authors.lastname: Lai
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000209:etiology* / Q000523:psychology*; D016022:Case-Control Studies; D004569:Electroencephalography; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000209:etiology* / Q000523:psychology*; D009483:Neuropsychological Tests; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy*; D017582:Renal Replacement Therapy
chemical_list: D015415:Biomarkers