Cognitive Disorders and Dementia in CKD: The Neglected Kidney-Brain Axis

EpidemiologicdatasuggestthatindividualsatallstagesofCKD haveahigherriskof developing cognitive disorders and dementia. This risk is generally explained by the high prevalence of both symptomatic and subclinical ischemic cerebrovascular lesions. However, other potential mechanisms, including direct neuronal injury by uremic toxins, could also be involved, especially in the absence of obvious cerebrovascular disease. We discuss the prevalence and characteristics of cognitive disordersanddementia inpatientswithCKD, brainimaging findings, andtraditional and nontraditional risk factors. Understanding the pathophysiologic interactions between renal impairment and brain function is important in order to minimize the risk for future cognitive impairment.