I often receive requests from readers to write about certain topics. Last week, a reader asked me if I’d ever written about chronic kidney disease and dementia. I checked the blog’s topic list, which is on the right-hand side of the blog post. Dementia was listed. I looked at each blog post that mentioned dementia, but that’s all each of them did – mention dementia. I’d never written a blog solely about dementia in relation to kidney disease. That’s what today’s blog will be about.
Let’s start in the usual manner with a definition and, yes, I did use my all-time favorite dictionary – the Merriam-Webster:
“a usually progressive condition (such as Alzheimer’s disease) marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior)”
I’ve failed to mention that this is personal. My husband has Alzheimer’s and was recently diagnosed with CKD. We’re not too worried about the CKD since he’s been following the CKD lifestyle with me since I was diagnosed back in 2008. That’s the kind of great guy he is. But now there’s this connection.
I turned to AJKD, the National Kidney Foundation’s American Journal of Kidney Disease, for more information about the connection:
“Recent studies in CKD patients suggest that the natural history of cognitive impairment begins before transition to ESRD, and that there is a strong graded relation between declining estimated glomerular filtration rate (eGFR) and cognitive function…. Below the eGFR threshold of 45 mL/min/1.73 m2 (stage 3B CKD, 0.75 mL/s/1.73 m2), risk of cognitive impairment more than doubles (odds ratio, 2.43) compared with higher eGFR. Approximately one-fourth of such patients have at least moderate cognitive impairment…. This suggests that once kidney function is reduced by more than half, cognitive reserve is also likely depleted and should be assessed.”
Uh, ‘cognitive impairment’? Is that another term for dementia? Let’s check with the Mayo Clinic:
“Mild cognitive impairment (MCI) is the stage between the expected decline in memory and thinking that happens with age and the more serious decline of dementia. MCI may include problems with memory, language or judgment.”
I very much wanted to know how dementia was expressed within our bodies. The National Kidney Foundation explained:
“Abnormalities in the capillaries, which are the smallest blood vessels in the body, are found in the brains of people who die of dementia. Similar capillary findings are observed in kidneys of people with albuminuria, leading scientists to predict that albuminuria and vascular disease of the brain may go hand in hand.
‘Persistent albuminuria means that the kidney has some damage and is starting to spill some albumin — a kind of protein — into the urine,’ said Dr. Kerry Willis, Senior Vice President for Scientific Activities, National Kidney Foundation. The most common causes of albuminuria are diabetes and high blood pressure.”
After scouring the internet, the most oft repeated fact I found is that the renal capillaries suffer inflammation from albuminuria. Inflammation? Let’s see if that’s present in those with dementia, too. Oh! Yes, in several types of dementia, capillary inflammation is a factor – especially when it widens the capillaries.
Helio had some interesting information for us:
“Assuming a direct association, our analysis suggest[s] that 10% of the dementia cases could be attributed to CKD, a proportion higher than that observed for other well-established dementia risk factors such as cardiovascular disease and diabetes,” Xu [“Hong Xu, MD, PhD, a postdoctoral researcher in the department of neurobiology, care sciences and society and the department of medical epidemiology and biostatistics at the Karolinska Institute in Stockholm”] and colleagues wrote.
Now what? With Bear having Alzheimer’s and me losing so much kidney function so quickly, I am far more than curious. What can we possibility do about this? It’s time to bring in the National Library of Medicine:
“Both conditions [hypertension and diabetes mellitus] share several risk factors … and are characterised by small vessel disease …. The cerebro-renal connection could be due to small vessel disease as both end organs have similar anatomical and physiologic characteristics…. Kidney dysfunction is related to small vessel disorders, including glomerular endothelium dysfunction and lipohyalinosis, a cerebral small vessel disease affecting small arteries, arterioles or capillaries in the brain.”
Okay, I’m still reeling. If liphyalinosis is a brain small vessel disease [and it is], do we try to correct it? Do we attempt to correct the other small vessel disorders? Or do we concentrate on the CKD? The hypertension? The diabetes?
This is what the National Center for Biotechnology Information offers:
“Specific to CKD, targeting a low blood pressure and reduction in albuminuria with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may slow cognitive decline, albeit modestly. Initiation of dialysis can improve severe impairment associated with uremia but does not appear to affect more subtle chronic cognitive impairment. In contrast, kidney transplantation appears to lead to improved cognitive function in many transplant recipients, suggesting that dialysis methods do not provide the same cognitive benefits as having a functioning kidney. Management of patients with both CKD and cognitive impairment should include a comprehensive plan including more frequent follow-up visits; involvement of family in shared decision making; measures to improve compliance, such as written instruction and pill counts; and a focus on advance directives in conjunction with an emphasis on understanding an individual patient’s life goals. Further research is needed on novel therapies, including innovative dialysis methods, that aim to limit the development of cognitive impairment, slow decline in those with prevalent impairment, and improve cognitive function.”
I don’t know whether to feel despair or hope. The management doesn’t sound terrible, but dialysis or transplant? I realize this is still early in the game, so I’ve decided to keep my wits about me. Of course, I’ll keep researching, too.
Until next week,
Keep living your life!
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