Cognitive impairment/dementia in chronic renal disease

Abstract

Chronic kidney disease (CKD) is a worldwide public health problem that is increasing in prevalence, especially in the elderly. CKD and/or end stage renal disease (ESRD) patients have numerous comorbidities that increase the risk of cognitive impairment and dementia (CI/D). In fact, almost every stage of CKD is associated with an increased risk of CI/D; the risk increases as the severity of CKD increases. The mechanisms responsible for this increased risk are largely due to the accelerated vascular disease of CKD/ESRD that leads to an increase in vascular dementia. However, other factors such as increased risk of thrombotic and hemorrhagic strokes, uremic toxins, and suboptimal aspects of dialytic therapies also contribute to the development and progression of CI/D. The importance of CI/D in CKD/ESRD patients is that it impairs quality of life, and carries with it a greater risk of hospitalization, disability, dialysis withdrawal, and mortality. Despite the magnitude of the problem, CI/D is largely under-recognized in the renal patient, and optimal management strategies are unknown. The aim of this chapter is to provide an overview of the epidemiology, pathogenesis/pathophysiology, diagnostic approaches, and therapeutic considerations for CI/D in patients with CKD/ESRD.