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Shi C, Jia S, Wang X, Liu C, Shao F, Shi Y, Li Z. Research on cognitive impairment and potential risk factors in peritoneal dialysis patients: An observational study. Medicine (Baltimore) 2024; 103:e38374. [PMID: 38996170 PMCID: PMC11245193 DOI: 10.1097/md.0000000000038374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/03/2024] [Indexed: 07/14/2024] Open
Abstract
The objective of this study is to investigate the associated risk factors and their effects on cognitive impairment (CI) in patients undergoing peritoneal dialysis. A retrospective analysis was conducted on the basic information of 268 patients who underwent continuous ambulatory peritoneal dialysis (CAPD) at our hospital from January 2020 to September 2023. Cognitive function was assessed using the Montreal Cognitive Assessment Scale during their subsequent dialysis visits. Participants were categorized into a CI group and a cognitively normal group. Blood and other biological samples were collected for relevant biomarker analysis. Subsequently, we analyzed and compared the factors influencing CI between the 2 groups. The prevalence of CI among CAPD patients was 58.2%. Compared to the cognitively normal group, the CI group had a higher prevalence of alcohol consumption, lower levels of education, and reduced serum uric acid levels (P < .05). There was also a higher incidence of autoimmune diseases such as systemic lupus erythematosus in the CI group (P < .05). In terms of dialysis efficacy, the residual kidney Kt/V and residual kidney Ccr were significantly lower in the CI group compared to the cognitively normal group. In blood parameters, the CI group showed elevated total cholesterol levels and lower serum calcium concentrations (P < .05). Logistic regression analysis identified male gender, older age, lower educational attainment, hypercholesterolemia, and elevated high-sensitivity C-reactive protein levels as independent risk factors for CI in CAPD patients (P < .05). Additionally, in this patient cohort, dialysis duration and residual renal function were protective factors against CI (P < .05). CI is prevalent among PD patients. Elevated high-sensitivity C-reactive protein levels, male gender, older age, lower educational attainment, and hypercholesterolemia constitute an independent risk factor for CI in CAPD patients, whereas residual renal function acts as a protective element.
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Affiliation(s)
- Chunxia Shi
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Shujing Jia
- Department of Neurology, Beijing Shuangqiao Hospital, Beijing, China
| | - Xiaoqi Wang
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Conghui Liu
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Feng Shao
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Yanan Shi
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
| | - Zhongxin Li
- Department of Nephrology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China
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2
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Yoshida Y, Fukuoka K, Sakugawa M, Kurogi M, Hamamura K, Hamasaki K, Tsurusaki F, Sotono K, Nishi T, Fukuda T, Kumamoto T, Oyama K, Ogino T, Tsuruta A, Mayanagi K, Yamashita T, Fuchino H, Kawahara N, Yoshimatsu K, Kawakami H, Koyanagi S, Matsunaga N, Ohdo S. Inhibition of G protein-coupled receptor 68 using homoharringtonine attenuates chronic kidney disease-associated cardiac impairment. Transl Res 2024; 269:31-46. [PMID: 38401836 DOI: 10.1016/j.trsl.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Chronic kidney disease (CKD) induces cardiac inflammation and fibrosis and reduces survival. We previously demonstrated that G protein-coupled receptor 68 (GPR68) promotes cardiac inflammation and fibrosis in mice with 5/6 nephrectomy (5/6Nx) and patients with CKD. However, no method of GPR68 inhibition has been found that has potential for therapeutic application. Here, we report that Cephalotaxus harringtonia var. nana extract and homoharringtonine ameliorate cardiac inflammation and fibrosis under CKD by suppressing GPR68 function. Reagents that inhibit the function of GPR68 were explored by high-throughput screening using a medicinal plant extract library (8,008 species), and we identified an extract from Cephalotaxus harringtonia var. nana as a GPR68 inhibitor that suppresses inflammatory cytokine production in a GPR68 expression-dependent manner. Consumption of the extract inhibited inflammatory cytokine expression and cardiac fibrosis and improved the decreased survival attributable to 5/6Nx. Additionally, homoharringtonine, a cephalotaxane compound characteristic of C. harringtonia, inhibited inflammatory cytokine production. Homoharringtonine administration in drinking water alleviated cardiac fibrosis and improved heart failure and survival in 5/6Nx mice. A previously unknown effect of C. harringtonia extract and homoharringtonine was revealed in which GPR68-dependent inflammation and cardiac dysfunction were suppressed. Utilizing these compounds could represent a new strategy for treating GPR68-associated diseases, including CKD.
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Affiliation(s)
- Yuya Yoshida
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Kohei Fukuoka
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Miyu Sakugawa
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Masayuki Kurogi
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Kengo Hamamura
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Keika Hamasaki
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Fumiaki Tsurusaki
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Kurumi Sotono
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Takumi Nishi
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Taiki Fukuda
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Taisei Kumamoto
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Kosuke Oyama
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Takashi Ogino
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Akito Tsuruta
- Department of Glocal Healthcare Science, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Kouta Mayanagi
- Department of Drug Discovery Structural Biology, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomohiro Yamashita
- Department of Drug Discovery Structural Biology, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroyuki Fuchino
- Tsukuba Division, Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition, 1-2 Hachimandai, Tsukuba, Ibaraki 305-0843, Japan
| | - Nobuo Kawahara
- Tsukuba Division, Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition, 1-2 Hachimandai, Tsukuba, Ibaraki 305-0843, Japan; The Kochi Prefectural Makino Botanical Garden, 4200-6, Godaisan, Kochi 781-8125, Japan
| | - Kayo Yoshimatsu
- Tsukuba Division, Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition, 1-2 Hachimandai, Tsukuba, Ibaraki 305-0843, Japan
| | - Hitomi Kawakami
- Tsukuba Division, Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition, 1-2 Hachimandai, Tsukuba, Ibaraki 305-0843, Japan
| | - Satoru Koyanagi
- Department of Glocal Healthcare Science, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan
| | - Naoya Matsunaga
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Shigehiro Ohdo
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
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Long JJ, Chen Y, Kim B, Bae S, Li Y, Orandi BJ, Chu NM, Mathur A, Segev DL, McAdams-DeMarco MA. Sleep Disorders and Dementia Risk in Older Patients with Kidney Failure: A Retrospective Cohort Study. Clin J Am Soc Nephrol 2024:01277230-990000000-00412. [PMID: 38913442 DOI: 10.2215/cjn.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Key Points
Older patients with kidney failure who are newly diagnosed with sleep disorders are at higher risk of developing any type of dementia, vascular dementia, and other/mixed types of dementia.For older patients with kidney failure who are diagnosed with obstructive sleep apnea, positive airway pressure therapy is an intervention that is associated with lower dementia risk.
Background
Community-dwelling older adults with sleep disorders are at higher risk of developing dementia. Greater than 50% of older patients with kidney failure experience sleep disorders, which may explain their high burden of dementia.
Methods
Among 216,158 patients (aged 66 years and older) with kidney failure (United States Renal Data System; 2008–2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional hazards models with propensity score weighting. We tested whether positive airway pressure (PAP) therapy was associated with reduced dementia risk among patients with obstructive sleep apnea (OSA).
Results
26.3% of patients were diagnosed with sleep disorders; these patients had a higher 5-year unadjusted cumulative incidence for any type of dementia (36.2% versus 32.3%; P < 0.001), vascular dementia (4.4% versus 3.7%; P < 0.001), and other/mixed dementia (29.3% versus 25.8%; P < 0.001). Higher risk of any type of dementia was identified in patients with insomnia (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [CI], 1.34 to 1.51), sleep-related breathing disorders (SRBDs) (aHR, 1.20, 95% CI, 1.17 to 1.23), and other sleep disorders (aHR, 1.24; 95% CI, 1.11 to 1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR, 1.43; 95% CI, 1.19 to 1.73) and SRBDs (aHR, 1.15; 95% CI, 1.07 to 1.24). Patients with SRBDs (aHR, 1.07; 95% CI, 1.00 to 1.15) were at higher risk of Alzheimer disease. Among patients with OSA, PAP therapy was associated with lower risk of any type of dementia (aHR, 0.82; 95% CI, 0.76 to 0.90) and vascular dementia (aHR, 0.65; 95% CI, 0.50 to 0.85).
Conclusions
Older patients with kidney failure and sleep disorders are at a higher risk of dementia. Sleep is an important modifiable factor that should be considered for targeted interventions to mitigate dementia risk in patients with kidney failure. For patients with OSA, PAP therapy is associated with lower dementia risk.
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Affiliation(s)
- Jane J Long
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Yusi Chen
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Byoungjun Kim
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Sunjae Bae
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Yiting Li
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Babak J Orandi
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Medicine, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
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4
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Zhang A, Furgeson S, Shapiro A, Bjornstad P, You Z, Tommerdahl KL, Dixon A, Stenson E, Oh E, Kendrick J. Assessing Cognition in CKD Using the National Institutes of Health Toolbox. KIDNEY360 2024; 5:834-840. [PMID: 38568010 PMCID: PMC11219111 DOI: 10.34067/kid.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/29/2024] [Indexed: 06/01/2024]
Abstract
Key Points Participants with CKD had detectable cognitive deficits in fluid cognition, dexterity, and total cognition. Sex differences in cognition exist in people with CKD. Background CKD is largely an age-related clinical disorder with accelerated cognitive and cardiovascular aging. Cognitive impairment is a well-documented occurrence in midlife and older adults with CKD and affects multiple domains. We examined cognition function and potential sex differences in cognition in adults with CKD. Methods We included 105 individuals (49.5% women) with CKD stage 3b–4 (eGFR, 15–44 ml/min) from the Bicarbonate Administration in CKD Trial (NCT02915601 ). We measured cognitive function using the National Institutes of Health Toolbox Cognition Battery, which assesses cognitive and motor measures, such as executive function, attention, memory, and dexterity. All study measures were collected and analyzed at the study baseline. Results The mean (SD) age and eGFR were 61±12 years and 34.9±9.8 ml/min per 1.73 m2. Overall, when compared with the National Institutes of Health Toolbox reference population, participants scored, on average, below the 50th percentile across all cognitive domain tests and the dexterity test. Total cognition scores were also below the 50th percentile. Participants with stage 4 CKD had significantly lower fluid cognition scores compared with those with CKD stage 3b (β -estimate −5.4 [95% confidence interval, −9.8 to −0.9]; P = 0.03). Female participants with CKD performed significantly better on the episodic memory tests and dexterity tests (dominant and nondominant pegboard tests) and had higher crystallized cognition scores, on average, compared with male participants. Conclusions Participants with CKD had detectable cognitive deficits in fluid cognition, dexterity, and total cognition. In addition, sex differences in cognitive measures were found among people with CKD.
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Affiliation(s)
- Alexander Zhang
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Seth Furgeson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Shapiro
- Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Petter Bjornstad
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kalie L. Tommerdahl
- Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angelina Dixon
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erin Stenson
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ester Oh
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Bossola M, Picconi B. Uremic toxins and the brain in chronic kidney disease. J Nephrol 2024:10.1007/s40620-024-01929-4. [PMID: 38625502 DOI: 10.1007/s40620-024-01929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/09/2024] [Indexed: 04/17/2024]
Abstract
Chronic kidney disease (CKD) patients have an increased risk for cognitive impairment compared to the general population. The risk is much higher in CKD patients who progress to end-stage kidney disease (ESKD) and require hemodialysis or peritoneal dialysis. Multiple factors may contribute to cognitive impairment in CKD patients and in patients on chronic dialysis. However, the observation that, after kidney transplantation, there is an improvement in several cognitive performance markers and that some structural and functional brain abnormalities may improve suggests that cognitive deficits in patients on dialysis may be at least partially reversible. Recent evidence supports the hypothesis that uremic toxins may disrupt the blood brain barrier and damage the brain cells. Such brain toxicity should prompt efforts to lower the burden of uremic toxins through dialytic and non-dialytic strategies.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Unit, Division of Nephrology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
| | - Barbara Picconi
- Laboratory of Experimental Neurophysiology, IRCCS San Raffaele, 00166, Rome, Italy
- Telematic University San Raffaele, 00166, Rome, Italy
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Trišins M, Zdanovskis N, Platkājis A, Šneidere K, Kostiks A, Karelis G, Stepens A. Brodmann Areas, V1 Atlas and Cognitive Impairment: Assessing Cortical Thickness for Cognitive Impairment Diagnostics. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:587. [PMID: 38674233 PMCID: PMC11052167 DOI: 10.3390/medicina60040587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Magnetic resonance imaging is vital for diagnosing cognitive decline. Brodmann areas (BA), distinct regions of the cerebral cortex categorized by cytoarchitectural variances, provide insights into cognitive function. This study aims to compare cortical thickness measurements across brain areas identified by BA mapping. We assessed these measurements among patients with and without cognitive impairment, and across groups categorized by cognitive performance levels using the Montreal Cognitive Assessment (MoCA) test. Materials and Methods: In this cross-sectional study, we included 64 patients who were divided in two ways: in two groups with (CI) or without (NCI) impaired cognitive function and in three groups with normal (NC), moderate (MPG) and low (LPG) cognitive performance according to MoCA scores. Scans with a 3T MRI scanner were carried out, and cortical thickness data was acquired using Freesurfer 7.2.0 software. Results: By analyzing differences between the NCI and CI groups cortical thickness of BA3a in left hemisphere (U = 241.000, p = 0.016), BA4a in right hemisphere (U = 269.000, p = 0.048) and BA28 in left hemisphere (U = 584.000, p = 0.005) showed significant differences. In the LPG, MPG and NC cortical thickness in BA3a in left hemisphere (H (2) = 6.268, p = 0.044), in V2 in right hemisphere (H (2) = 6.339, p = 0.042), in BA28 in left hemisphere (H (2) = 23.195, p < 0.001) and in BA28 in right hemisphere (H (2) = 10.015, p = 0.007) showed significant differences. Conclusions: Our study found that cortical thickness in specific Brodmann Areas-BA3a and BA28 in the left hemisphere, and BA4a in the right-differ significantly between NCI and CI groups. Significant differences were also observed in BA3a (left), V2 (right), and BA28 (both hemispheres) across LPG, MPG, NC groups. Despite a small sample size, these findings suggest cortical thickness measurements can serve as effective biomarkers for cognitive impairment diagnosis, warranting further validation with a larger cohort.
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Affiliation(s)
- Maksims Trišins
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia; (M.T.)
| | - Nauris Zdanovskis
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia; (M.T.)
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ardis Platkājis
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia; (M.T.)
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia
| | - Kristīne Šneidere
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia
- Department of Health Psychology and Pedagogy, Riga Stradins University, LV-1007 Riga, Latvia
| | - Andrejs Kostiks
- Department of Neurology and Neurosurgery, Riga East University Hospital, LV-1038 Riga, Latvia (G.K.)
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, LV-1038 Riga, Latvia (G.K.)
- Department of Infectology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ainārs Stepens
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia
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7
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Brown C, Prusynski R, Baylor C, Humbert A, Mroz TM. Patient Characteristics and Treatment Patterns for Speech-Language Pathology Services in Skilled Nursing Facilities. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:912-936. [PMID: 38215225 DOI: 10.1044/2023_ajslp-23-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services. METHOD Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries. RESULTS Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11-3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity. CONCLUSIONS The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision.
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Affiliation(s)
- Cait Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Rachel Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Andrew Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle
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8
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Levassort H, Pépin M. [Neurocognitive disorders in chronic kidney disease]. SOINS. GERONTOLOGIE 2024; 29:21-26. [PMID: 38418068 DOI: 10.1016/j.sger.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Neurocognitive disorders (NCD) are common in patients with chronic kidney disease (CKD). It is essential to identify and characterize these disorders at an early stage, so as to be able to offer appropriate treatment. In a chronic disease such as CKD, the patient's involvement in decision-making is a major challenge, given the prospects for suppletive treatment: hemodialysis, peritoneal dialysis, kidney transplantation or non-dialytic drug therapy. Many factors are associated with the development and progression of NCD in patients with CKD, and a variety of conditions can influence the outcome of cognitive assessment in these patients.
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Affiliation(s)
- Hélène Levassort
- Service de néphrologie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, Boulogne-Billancourt, France; Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, Boulogne-Billancourt, France; Inserm UMRS 1018, Équipe épidémiologie clinique, Université Paris-Saclay, UVSQ, CESP, Villejuif, France.
| | - Marion Pépin
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, Boulogne-Billancourt, France; Inserm UMRS 1018, Équipe épidémiologie clinique, Université Paris-Saclay, UVSQ, CESP, Villejuif, France
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9
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Wang XH, He Y, Zhou H, Xiao T, Du R, Zhang X. Risk factors for cognitive impairment in patients with chronic kidney disease. World J Psychiatry 2024; 14:308-314. [PMID: 38464766 PMCID: PMC10921279 DOI: 10.5498/wjp.v14.i2.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients have been found to be at risk of concurrent cognitive dysfunction in previous studies, which has now become an important public health issue of widespread concern. AIM To investigate the risk factors for concurrent cognitive dysfunction in patients with CKD. METHODS This is a prospective cohort study conducted among patients with CKD between October 2021 and March 2023. A questionnaire was formulated by literature review and expert consultation and included questions about age, sex, education level, per capita monthly household income, marital status, living condition, payment method, and hypertension. RESULTS Logistic regression analysis showed that patients aged 60-79 years [odds ratio (OR) = 1.561, P = 0.015] and ≥ 80 years (OR = 1.760, P = 0.013), participants with middle to high school education (OR = 0.820, P = 0.027), divorced or widowed individuals (OR = 1.37, P = 0.032), self-funded patients (OR = 2.368, P = 0.008), and patients with hypertension (OR = 2.011, P = 0.041) had a higher risk of cognitive impairment. The risk of cognitive impairment was lower for those with a college degree (OR = 0.435, P = 0.034) and married individuals. CONCLUSION The risk factors affecting cognitive dysfunction are age, 60-79 years and ≥ 80 years; education, primary school education or less; marital status, divorced or widowed; payment method, self-funded; hypertension; and CKD.
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Affiliation(s)
- Xiao-Hui Wang
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Yong He
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Huan Zhou
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Ting Xiao
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
| | - Ran Du
- Department of Nephrology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
| | - Xin Zhang
- Department of Nephrology, The Fifth Hospital of Wuhan, Wuhan 430050, Hubei Province, China
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10
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Chan FHF, Goh ZZS, Zhu X, Tudor Car L, Newman S, Khan BA, Griva K. Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis. Health Psychol Rev 2023; 17:614-640. [PMID: 36200562 DOI: 10.1080/17437199.2022.2132980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.
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Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zack Z S Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoli Zhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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11
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Manewell SM, Rao P, Haneman K, Zheng M, Charaf H, Menz HB, Sherrington C, Paul SS. Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review. J Foot Ankle Res 2023; 16:81. [PMID: 37986004 PMCID: PMC10659051 DOI: 10.1186/s13047-023-00679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Foot and lower limb health complications are common among patients undergoing dialysis; but a summary of prevention and management evidence is not available. The aim of this scoping review was to summarise study characteristics and the nature of results regarding strategies to prevent and manage peripheral arterial disease (PAD), foot ulceration, amputation, associated infection and associated hospital admission in adults undergoing dialysis. METHODS MEDLINE, Embase, CINAHL and AMED databases were searched for longitudinal experimental and observational studies. Eligible studies included adults undergoing dialysis (≥10 dialysis patients, with separate results or ≥ 75% of the cohort). Any interventions relating to PAD, foot ulceration, amputation, associated infection, and associated hospital admission were included. RESULTS The review included 212 studies, of which 199 were observational (94%) and 13 were experimental (6%). Sixteen studies (8%) addressed the prevention of foot and lower limb health complications, 43 (20%) addressed management, and 153 (72%) addressed both. The main intervention type in each study was surgery (n = 159, 75%), care from one or more health professionals (n = 13, 6%), screening by a health professional (n = 10, 5%), medication (n = 9, 4%) and rehabilitation (n = 5, 2%). No studies were identified where exercise, offloading or education were the main intervention. Results for PAD were reported in 137 (65%) studies, foot ulceration in 54 (25%), amputation in 171 (81%), infection in 7 (3%), and admission in 26 studies (12%). Results for more than one foot or lower limb outcome were reported in 141 studies (67%), with each study reporting on average two outcomes. Results varied and spanned positive, negative, and neutral outcomes following intervention. CONCLUSIONS Identified studies frequently aimed to both prevent and manage foot and lower limb health complications. A variety of interventions were identified and studies often reported results for more than one foot or lower limb health outcome. Findings from this review can be used to guide future research, with a goal to support improved patient outcomes.
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Affiliation(s)
- Sarah M Manewell
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia.
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia.
| | - Purnima Rao
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Keren Haneman
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Minjia Zheng
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia
| | - Hady Charaf
- Faculty of Podiatric Medicine, School of Health Sciences, Western Sydney University, NSW, Campbelltown, Australia
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney/Sydney Local Health District, NSW, Camperdown, Australia
| | - Serene S Paul
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia
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12
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Fukuoka K, Yoshida Y, Sotono K, Nishikawa N, Hamamura K, Oyama K, Tsuruta A, Mayanagi K, Koyanagi S, Matsunaga N, Ohdo S. Oral administration of vancomycin alleviates heart failure triggered by chronic kidney disease. Biochem Biophys Res Commun 2023; 675:92-98. [PMID: 37463524 DOI: 10.1016/j.bbrc.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023]
Abstract
Chronic kidney disease (CKD) induces an imbalance in the intestinal microbiota, affecting various physiological functions and leading to cardiovascular inflammation and fibrosis. However, the cardiotoxic impact of intestinal microbiota-derived uremic substances in advanced renal dysfunction remains unexplored. Therefore, we developed a 5/6 nephrectomy (5/6Nx) mouse model to investigate the intestinal microbiota and the effects of administering vancomycin (VCM) on the microbiota and the cardiac pathology associated with CKD. Despite VCM administration after the development of irreversible glomerulosclerosis and tubulointerstitial fibrosis, blood indoxyl sulfate and phenyl sulfate levels, which are intestinal bacteria-derived uremic substances, brain natriuretic peptide levels, and the fibrotic area in the heart were decreased. Moreover, VCM administration prevented 5/6Nx-induced weight loss and prolonged survival time. Our findings suggest that VCM-induced changes in the intestinal microbiota composition ameliorate heart failure and improve survival rates by reducing intestinal microbiota-derived cardiotoxic substances despite advanced renal dysfunction. This highlights the potential of using the intestinal microbiota as a target to prevent and treat cardiovascular conditions associated with CKD.
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Affiliation(s)
- Kohei Fukuoka
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuya Yoshida
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kurumi Sotono
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoki Nishikawa
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kengo Hamamura
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kosuke Oyama
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akito Tsuruta
- Department of Glocal Healthcare Science, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kota Mayanagi
- Department of Drug Discovery Structural Biology, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoru Koyanagi
- Department of Glocal Healthcare Science, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoya Matsunaga
- Department of Clinical Pharmacokinetics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shigehiro Ohdo
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
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13
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Wang Y, Chen K, Qiao ZX, Bao XR. Chronic Kidney Disease Induces Cognitive Impairment in the Early Stage. Curr Med Sci 2023; 43:988-997. [PMID: 37755634 DOI: 10.1007/s11596-023-2783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/07/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Previous research indicates a link between cognitive impairment and chronic kidney disease (CKD), but the underlying factors are not fully understood. This study aimed to investigate the progression of CKD-induced cognitive impairment and the involvement of cognition-related proteins by developing early- and late-stage CKD models in Sprague-Dawley rats. METHODS The Morris water maze test and the step-down passive avoidance task were performed to evaluate the cognitive abilities of the rats at 24 weeks after surgery. Histopathologic examinations were conducted to examine renal and hippocampal damage. Real-time PCR, Western blotting analysis, and immunohistochemical staining were carried out to determine the hippocampal expression of brain-derived neurotrophic factor (BDNF), choline acetyltransferase (ChAT), and synaptophysin (SYP). RESULTS Compared with the control rats, the rats with early-stage CKD exhibited mild renal damage, while those with late-stage CKD showed significantly increased serum creatinine levels as well as apparent renal and brain damage. The rats with early-stage CKD also demonstrated significantly impaired learning abilities and memory compared with the control rats, with further deterioration observed in the rats with late-stage CKD. Additionally, we observed a significant downregulation of cognition-related proteins in the hippocampus of rats with early-stage CKD, which was further exacerbated with declining renal function as well as worsening brain and renal damage in rats with late-stage CKD. CONCLUSION These results suggest the importance of early screening to identify CKD-induced cognitive dysfunction promptly. In addition, the downregulation of cognition-related proteins may play a role in the progression of cognitive dysfunction.
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Affiliation(s)
- Yu Wang
- Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Kai Chen
- Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Zi-Xuan Qiao
- Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Xiao-Rong Bao
- Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508, China.
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14
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Xu S, Wang J, Sun K, Meng L, Qin C, Feng R, Tian Y, Zhai Y, Liang D, Zhang R, Tian H, Liu H, Chen Y, Fu Y, Chen P, Zhu Q, Teng J, Wang X. Cognitive Impairment in Chronic Kidney Disease Is Associated with Glymphatic System Dysfunction. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:384-397. [PMID: 37901711 PMCID: PMC10601941 DOI: 10.1159/000530635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/01/2023] [Indexed: 10/31/2023]
Abstract
Introduction This study was designed to explore the associations between impaired cognition in chronic kidney disease (CKD) patients and the dysfunction of the glymphatic system. Method Data were obtained from 77 CKD patients and 50 age-matched healthy control individuals from the First Affiliated Hospital of Zhengzhou University. CKD patients were stratified into with and without impaired cognitive function. T2-weighted magnetic resonance imaging results were used to assess area ratios for the perivascular space and ventricles in participants, while the Montreal Cognitive Assessment and the Mini-Mental State Examination were employed to measure cognitive function. Correlations between the perivascular space or ventricle area ratios and cognitive impairment were assessed in CKD patients. Results Significant increases in the burden of enlarged perivascular spaces in the frontal cortex and basal ganglia were observed in CKD patients with cognitive impairment relative to those without such impairment, with a concomitant increase in analyzed ventricle area ratios. Enlarged perivascular spaces in the frontal cortex, basal ganglia and increased area ratios of lateral ventricles and 4th ventricle exhibited relatively high sensitivity and specificity as means of differing between the CKD patients with and without cognitive impairment. Conclusion These results indicate that the burden of enlarged perivascular spaces in the frontal cortex and basal ganglia and increases in ventricle area ratio values may offer utility as biomarkers that can aid in detection of even mild cognitive decline in individuals with CKD. The dysfunction of the glymphatic system may play a key role in the pathogenesis of CKD-related cognitive impairment.
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Affiliation(s)
- Shuqin Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Jiuqi Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Kedi Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Lin Meng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Chi Qin
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Renyi Feng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Yiming Tian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Yanping Zhai
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Dongxiao Liang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Rui Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Haiyan Tian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Han Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Yongkang Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Yu Fu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Pei Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Qingyong Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
| | - Xuejing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, China
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15
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Husain-Syed F, Takeuchi T, Neyra JA, Ramírez-Guerrero G, Rosner MH, Ronco C, Tolwani AJ. Acute kidney injury in neurocritical care. Crit Care 2023; 27:341. [PMID: 37661277 PMCID: PMC10475203 DOI: 10.1186/s13054-023-04632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
Approximately 20% of patients with acute brain injury (ABI) also experience acute kidney injury (AKI), which worsens their outcomes. The metabolic and inflammatory changes associated with AKI likely contribute to prolonged brain injury and edema. As a result, recognizing its presence is important for effectively managing ABI and its sequelae. This review discusses the occurrence and effects of AKI in critically ill adults with neurological conditions, outlines potential mechanisms connecting AKI and ABI progression, and highlights AKI management principles. Tailored approaches include optimizing blood pressure, managing intracranial pressure, adjusting medication dosages, and assessing the type of administered fluids. Preventive measures include avoiding nephrotoxic drugs, improving hemodynamic and fluid balance, and addressing coexisting AKI syndromes. ABI patients undergoing renal replacement therapy (RRT) are more susceptible to neurological complications. RRT can negatively impact cerebral blood flow, intracranial pressure, and brain tissue oxygenation, with effects tied to specific RRT methods. Continuous RRT is favored for better hemodynamic stability and lower risk of dialysis disequilibrium syndrome. Potential RRT modifications for ABI patients include adjusted dialysate and blood flow rates, osmotherapy, and alternate anticoagulation methods. Future research should explore whether these strategies enhance outcomes and if using novel AKI biomarkers can mitigate AKI-related complications in ABI patients.
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Affiliation(s)
- Faeq Husain-Syed
- Division of Nephrology, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Tomonori Takeuchi
- Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ku, Tokyo, 113-8510, Japan
| | - Javier A Neyra
- Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, San Ignacio 725, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, San Ignacio 725, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Hontaneda 2653, Valparaíso, Chile
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA
| | - Claudio Ronco
- Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2, 35128, Padua, Italy
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Ashita J Tolwani
- Division of Nephrology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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16
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Chan FHF, Newman S, Khan BA, Griva K. Prevalence and trajectories of subjective cognitive complaints and implications for patient outcomes: A prospective study of haemodialysis patients. Br J Health Psychol 2023; 28:651-671. [PMID: 36720474 DOI: 10.1111/bjhp.12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Cognitive impairment is common in haemodialysis patients and is associated with increased hospitalization and mortality. However, subjective cognitive complaints (SCCs), the self-experienced difficulties in everyday cognitive activities, remain poorly understood. This study examined the prevalence and course of SCCs in haemodialysis patients and its longitudinal associations with sociodemographic, clinical and patient-reported variables. DESIGN Observational prospective study with baseline and 12-month follow-up assessment. METHODS Based on a validated cut-off point on the Kidney Disease Quality of Life Cognitive Function subscale, haemodialysis patients (N = 159; 40.3% female, mean age 53.62) were classified into cognitive complaint trajectories: (1) resilient (60.4%; no/low SCCs throughout); (2) persistent (8.8%; stable high SCCs); (3) deterioration (17.6%; from no/low to high SCCs); and (4) recovery (13.2%; from high to no/low SCCs). Sociodemographic/clinical characteristics, self-efficacy, self-management skills, adherence, mood and biochemical assays were measured at both assessments and compared among trajectories using mixed ANOVAs. RESULTS Interaction effects indicated significant improvements in the recovery group in clinical outcomes (i.e., decreased phosphorus and calcium-phosphorus product), self-efficacy and mood over time. Group effects indicated significantly poorer self-efficacy, self-management skills and adherence in the persistent group than other trajectories across both assessments. None of the sociodemographic/clinical characteristics was associated with SCC trajectories. CONCLUSIONS The extent of SCCs vary over time across haemodialysis patients. Routine screening of SCCs in dialysis settings may help identifying patients at risk of poor self-management and worse prognosis. Strategies that compensate for cognitive lapses may mitigate the perceived cognitive burden of this population.
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Affiliation(s)
- Frederick H F Chan
- Population/Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Stanton Newman
- Division of Health Services Research and Management, School of Health Sciences, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore City, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Konstadina Griva
- Population/Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
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17
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Pépin M, Klimkowicz-Mrowiec A, Godefroy O, Delgado P, Carriazo S, Ferreira AC, Golenia A, Malyszko J, Grodzicki T, Giannakou K, Paolisso G, Barbieri M, Garneata L, Mocanu CA, Liabeuf S, Spasovski G, Zoccali C, Bruchfeld A, Farinha A, Arici M, Capasso G, Wiecek A, Massy ZA. Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment. Eur J Neurol 2023; 30:2899-2911. [PMID: 37326125 DOI: 10.1111/ene.15928] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition. METHODS Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives. RESULTS A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce. CONCLUSIONS There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.
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Affiliation(s)
- Marion Pépin
- INSERM (Institut National de la Santé et de la recherche médicale) Unit 1018, Clinical Epidemiology, CESP (Centre d'Epidemiologie et de Santé des Populations), Hôpital Paul Brousse, Paris-Saclay University and Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Department of Geriatrics, Ambroise Paré University Hospital, APHP (Assistance Publique - Hôpitaux de Paris), Boulogne-Billancourt/Paris, France
| | | | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (Research Unit 4559), Jules Verne University of Picardie (UPJV), Amiens, France
| | - Pilar Delgado
- Department of Neurology, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sol Carriazo
- Department of Nephrology and Hypertension, Instituto de Investigacion Sanitaria (IIS)-Fundacion Jimenez Diaz, Autonomous University of Madrid (UAM), Madrid, Spain
| | - Ana Carina Ferreira
- Department of Nephrology, Centro Hospitalar e Universitário de Lisboa Central-Hospital Curry Cabral, Lisbon, Portugal
- Universidade Nova de Lisboa-Faculdade de Ciências Médicas-Nephology, Lisbon, Portugal
| | | | - Jolanta Malyszko
- Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- UniCAMILLUS, International Medical University, Roma, Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Liliana Garneata
- Department of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Carmen Antonia Mocanu
- Department of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Sophie Liabeuf
- Pharmacology Department, Amiens University Medical Center, Amiens, France
- MP3CV (Mécanismes physiopathologiques et Conséquences des Calcifications Cardio-Vasculaires) Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Goce Spasovski
- University Department of Nephrology, Clinical Center "Mother Theresa", University of Saints Cyril and Methodius, Skopje, North Macedonia
| | - Carmine Zoccali
- Renal Research Institute, New York, New York, USA
- Associazione Ipertensione Nefrologia Trapianto Renale, Reggio Calabria, Italy
| | - Annette Bruchfeld
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
- CLINTEC, Renal Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ana Farinha
- Department of Nephrology, Centro Hospitalar de Setúbal, Setubal, Portugal
| | - Mustafa Arici
- Department of Internal Medicine, Division of Nephrology, Hacetepe University, Faculty of Medicine, Ankara, Turkey
| | - Giovambattista Capasso
- Biogem (Molecular Biology and Genetics Research Institute), Ariano Irpino, Italy
- Department of Translational Medical Sciences, University of Campania, Naples, Italy
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation, and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Ziad A Massy
- INSERM (Institut National de la Santé et de la recherche médicale) Unit 1018, Clinical Epidemiology, CESP (Centre d'Epidemiologie et de Santé des Populations), Hôpital Paul Brousse, Paris-Saclay University and Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris, France
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18
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Xue Y, Wu Z, Li B, Sun G, Jia F, Liu K. Changes in Cerebral Blood Flow in Patients Who Receive Different Durations of Hemodialysis: An Arterial Spin Labeling MRI Study. J Clin Neurol 2023; 19:438-446. [PMID: 37455502 PMCID: PMC10471545 DOI: 10.3988/jcn.2022.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the changes in cerebral blood flow (CBF) in patients who received different durations of hemodialysis (HD) using arterial spin labeling magnetic resonance imaging. METHODS The study included 46 patients who received HD and 24 demographically similar healthy controls (HCs). Patients who received HD were divided into three subgroups based on its duration: HD-1 (n=15, dialysis duration ≤24 months), HD-2 (n=16, dialysis duration >24 and ≤72 months), and HD-3 (n=15, dialysis duration ≥73 months). All subjects completed the Mini Mental State Examination and Montreal Cognitive Assessment tests, and the patients who received HD underwent laboratory tests. Group-level differences in the global and regional CBFs between patients who received HD and HCs were assessed. Correlation analysis was performed to evaluate the associations among CBF, clinical variables, and cognitive function. RESULTS Compared with HCs, global and regional CBFs were significantly increased in the HD-1 and HD-2 groups (p<0.05), but there was no significant difference in the HD-3 group (p>0.05). However, compared with the HD-1 group, the HD-3 group had significantly decreased global and regional CBFs (p<0.05). The cognitive function was worse in patients who received long-term HD than in HCs. Increased dialysis duration and hemoglobin level were predictive risk factors for decreased CBF in patients who received long-term HD. CONCLUSIONS Patients who received long-term HD with normal CBF had worse cognitive function, which may be related to increased dialysis duration.
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Affiliation(s)
- Yan Xue
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhuanzhuan Wu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bo Li
- Department of Radiological Diagnosis, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China
| | - Gang Sun
- Department of Radiological Diagnosis, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China
| | - Fengyu Jia
- Department of Nephrology, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China.
| | - Kai Liu
- Department of Radiological Diagnosis, The 960th Hospital of the People's Liberation Army Joint Logistics Support Force, Jinan, China.
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19
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Giannakou K, Golenia A, Liabeuf S, Malyszko J, Mattace-Raso F, Farinha A, Spasovski G, Hafez G, Wiecek A, Capolongo G, Capasso G, Massy ZA, Pépin M. Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease. Front Med (Lausanne) 2023; 10:1215583. [PMID: 37621458 PMCID: PMC10446481 DOI: 10.3389/fmed.2023.1215583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies' limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.
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Affiliation(s)
- Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Francesco Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ana Farinha
- Department of Nephrology, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Goce Spasovski
- University Department of Nephrology, Clinical Centre “Mother Theresa”University Sts Cyril and Methodius, Skopje, North Macedonia
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Türkiye
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Ziad A. Massy
- Service de Néphrologie, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris & Université Paris-Saclay (Versailles-Saint-Quentin-en-Yvelines), Boulogne Billancourt, France
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Marion Pépin
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Departement of Geriatric Medicine, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
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20
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Zhao Y, Zheng Q, Hong Y, Gao Y, Hu J, Lang M, Zhang H, Zhou Y, Luo H, Zhang X, Sun H, Yan XX, Huang TY, Wang YJ, Xu H, Liu C, Wang X. β 2-Microglobulin coaggregates with Aβ and contributes to amyloid pathology and cognitive deficits in Alzheimer's disease model mice. Nat Neurosci 2023:10.1038/s41593-023-01352-1. [PMID: 37264159 DOI: 10.1038/s41593-023-01352-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
Extensive studies indicate that β-amyloid (Aβ) aggregation is pivotal for Alzheimer's disease (AD) progression; however, cumulative evidence suggests that Aβ itself is not sufficient to trigger AD-associated degeneration, and whether other additional pathological factors drive AD pathogenesis remains unclear. Here, we characterize pathogenic aggregates composed of β2-microglobulin (β2M) and Aβ that trigger neurodegeneration in AD. β2M, a component of major histocompatibility complex class I (MHC class I), is upregulated in the brains of individuals with AD and constitutes the amyloid plaque core. Elevation of β2M aggravates amyloid pathology independent of MHC class I, and coaggregation with β2M is essential for Aβ neurotoxicity. B2m genetic ablation abrogates amyloid spreading and cognitive deficits in AD mice. Antisense oligonucleotide- or monoclonal antibody-mediated β2M depletion mitigates AD-associated neuropathology, and inhibition of β2M-Aβ coaggregation with a β2M-based blocking peptide ameliorates amyloid pathology and cognitive deficits in AD mice. Our findings identify β2M as an essential factor for Aβ neurotoxicity and a potential target for treating AD.
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Affiliation(s)
- Yini Zhao
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, China
| | - Qiuyang Zheng
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, China
| | - Yujuan Hong
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
| | - Yue Gao
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
| | - Jiaojiao Hu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
| | - Maoju Lang
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
| | - Hongfeng Zhang
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, China
| | - Ying Zhou
- National Institute for Data Science in Health and Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Hong Luo
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
| | - Xian Zhang
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
| | - Hao Sun
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China
| | - Xiao-Xin Yan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, China
| | - Timothy Y Huang
- Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Yan-Jiang Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huaxi Xu
- Center for Brain Sciences, the First Affiliated Hospital of Xiamen University, Institute of Neuroscience, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Xiamen University, Xiamen, China
- Institute for Brain Science and Disease, Chongqing Medical University, Chongqing, China
| | - Cong Liu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
| | - Xin Wang
- State Key Laboratory of Cellular Stress Biology, Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, China.
- Shenzhen Research Institute of Xiamen University, Shenzhen, China.
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21
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Crepeau P, Fedorova T, Morris-Wiseman LF, Mathur A. Secondary Hyperparathyroidism and Cognitive Decline. CURRENT TRANSPLANTATION REPORTS 2023; 10:60-68. [PMID: 38707996 PMCID: PMC11068066 DOI: 10.1007/s40472-023-00394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 05/07/2024]
Abstract
Purpose of Review Secondary hyperparathyroidism (SHPT) likely contributes to the high prevalence of cognitive decline found among individuals with end-stage kidney disease (ESKD). Our objective is to critically evaluate the recent literature regarding the association between SHPT and cognitive decline and identify potential mechanisms. Recent Findings Nine studies assessing the relationship between SHPT and cognition have been published in the last two decades, each showing that elevated parathyroid hormone (PTH) levels were associated with cognitive decline. One also found structural changes within the brain related to SHPT. Additionally, two found that SHPT treatment decreases the risk of cognitive decline in ESKD patients. Summary SHPT is associated with cognitive impairment. However, the severity of SHPT associated with these changes and the specific cognitive domains affected remain unclear. Future studies are needed to focus on specific cognitive domains, the trajectory of cognitive decline, and optimal treatment strategies including the impact of kidney transplant and tertiary hyperparathyroidism.
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Affiliation(s)
- Philip Crepeau
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
| | - Tatiana Fedorova
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
| | - Lilah F. Morris-Wiseman
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
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22
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Yang Y, Li Q, Long Y, Yuan J, Zha Y. Associations of metabolic syndrome, its severity with cognitive impairment among hemodialysis patients. Diabetol Metab Syndr 2023; 15:108. [PMID: 37221557 DOI: 10.1186/s13098-023-01080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND In the general population, metabolic syndrome (MetS) is associated with increased risk of cognitive impairment, including global and specific cognitive domains. These associations are not well studied in patients undergoing hemodialysis and were the focus of the current investigation. METHODS In this multicenter cross-sectional study, 5492 adult hemodialysis patients (3351 men; mean age: 54.4 ± 15.2 years) treated in twenty-two dialysis centers of Guizhou, China were included. The Mini-Mental State Examination (MMSE) was utilized to assess mild cognitive impairment (MCI). MetS was diagnosed with abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. Multivariate logistic and linear regression models were used to examine the associations of MetS, its components, and metabolic scores with the risk of MCI. Restricted cubic spline analyses were performed to explore the dose-response associations. RESULTS Hemodialysis patients had a high prevalence of MetS (62.3%) and MCI (34.3%). MetS was positively associated with MCI risk with adjusted ORs of 1.22 [95% confidence interval (CI) 1.08-1.37, P = 0.001]. Compared to no MetS, adjusted ORs for MCI were 2.03 (95% CI 1.04-3.98) for 22.51 (95% CI 1.28-4.90) for 3, 2.35 (95% CI 1.20-4.62) for 4, and 2.94 (95% CI 1.48-5.84) for 5 components. Metabolic syndrome score, cardiometabolic index, and metabolic syndrome severity score were associated with increased risk of MCI. Further analysis showed that MetS was negatively associated with MMSE score, orientation, registration, recall and language (P < 0.05). Significant interaction effect of sex (P for interaction = 0.012) on the MetS-MCI was observed. CONCLUSION Metabolic syndrome was associated with MCI in hemodialysis patients in a positive dose-response effect.
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Affiliation(s)
- Yuqi Yang
- Deparment of Nephrology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
- NHC Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Qian Li
- Deparment of Nephrology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
- NHC Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yanjun Long
- Deparment of Nephrology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
- NHC Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Jing Yuan
- Deparment of Nephrology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
- NHC Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yan Zha
- Deparment of Nephrology, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
- NHC Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
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23
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Kim DK, Kang SH, Kim JS, Kim YG, Lee YH, Lee DY, Ahn SY, Moon JY, Lee SH, Jeong KH, Hwang HS. Clinical implications of circulating follistatin-like protein-1 in hemodialysis patients. Sci Rep 2023; 13:6637. [PMID: 37095121 PMCID: PMC10126138 DOI: 10.1038/s41598-023-33545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
Follistatin-like protein-1 (FSTL-1) is secreted glycoprotein, which regulates cardiovascular, immune and skeletal system. However, the clinical significance of circulating FSTL-1 levels remains unclear in hemodialysis patients. A total 376 hemodialysis patients were enrolled from June 2016 to March 2020. Plasma FSTL-1 level, inflammatory biomarkers, physical performance, and echocardiographic findings at baseline were examined. Plasma FSTL-1 levels were positively correlated with TNF-α and MCP-1. Handgrip strength showed weak positive correlation in male patients only, and gait speed showed no correlation with FSTL-1 levels. In multivariate linear regression analysis, FSTL-1 level was negatively associated with left ventricular ejection fraction (β = - 0.36; p = 0.011). The cumulative event rate of the composite of CV event and death, and cumulative event rate of CV events was significantly greater in FSTL-1 tertile 3. In multivariate Cox-regression analysis, FSTL-1 tertile 3 was associated with a 1.80-fold risk for the composite of CV events and death(95% confidence interval (CI) 1.06-3.08), and a 2.28-fold risk for CV events (95% CI 1.15-4.51) after adjustment for multiple variables. In conclusion, high circulating FSTL-1 levels independently predict the composite of CV events and death, and FSTL-1 level was independently associated with left ventricular systolic dysfunction.
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Affiliation(s)
- Dae Kyu Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jin Sug Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Dong-Young Lee
- Division of Nephrology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ju Young Moon
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Ho Lee
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea.
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24
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Nishimura A, Hidaka S, Kawaguchi T, Watanabe A, Mochida Y, Ishioka K, Mwanatanbwe M, Ohtake T, Kobayashi S. Relationship between Lower Extremity Peripheral Arterial Disease and Mild Cognitive Impairment in Hemodialysis Patients. J Clin Med 2023; 12:jcm12062145. [PMID: 36983147 PMCID: PMC10058216 DOI: 10.3390/jcm12062145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
Background: The link between arterial stiffness and mild cognitive impairment (MCI) in patients on hemodialysis (HD) has been receiving increased attention. The purpose of this study was to investigate the relationship between cognitive function and ankle brachial index (ABI) and toe brachial index (TBI) values in patients on hemodialysis. Of the 100 participants (mean age: 67.9 years; average history of hemodialysis: 7.3 years). Of these, 46.0% had MCI. The MoCA-J scores were significantly higher in the ABI ≥ 1.06 group. However, the MoCA-J scores divided into the two groups according to the TBI cutoff value were not significantly different. In a multiple regression model with the MoCA-J scores as the objective variable, the ABI was a significantly associated factor. This study indicates that a low ABI might be associated with MCI.
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Affiliation(s)
- Akinori Nishimura
- Rehabilitation Unit, Shonan Kamakura General Hospital, Okamoto 1370_1, Kamakura 247-8533, Japan
- Correspondence:
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira 187-8553, Japan
| | - Aki Watanabe
- School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Milanga Mwanatanbwe
- Department of Pathology, University of Mbuji-Mayi, Mbuji-Mayi 8010, Democratic Republic of the Congo
- International Division of Tokushukai of Medical Corporation, Tokushukai, Chiyoda-ku 102-0074, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
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25
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Miyazaki S, Kitamura M, Hayashida M, Tamaki A, Tomura H, Yamaguchi K, Nishino T, Funakoshi S. Survival and cognitive deterioration in elderly patients undergoing hemodialysis. Geriatr Gerontol Int 2023; 23:111-116. [PMID: 36608644 DOI: 10.1111/ggi.14531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
AIM This study aimed to elucidate the 5-year changes in the cognitive function of elderly patients undergoing hemodialysis and its association with survival and related factors. METHODS Cognitive function in patients aged ≥65 years undergoing hemodialysis at the Nagasaki Renal Center was assessed using the Mini-Mental State Examination (MMSE) in 2016. Patients were subsequently classified into normal, mild cognitive impairment (MCI) and suspected dementia groups according to their scores; MMSE was conducted at 30 and 60 months thereafter. The patients were followed until 2021. The association between survival and patient backgrounds was analyzed. RESULTS Of the 181 patients, 168 completed follow-up and were classified into normal (n = 71, 42.3%), MCI (n = 44, 26.1%), and suspected dementia (n = 53, 31.5%) groups. Multivariable logistic regression analysis showed that age, female sex, and geriatric nutritional risk index were associated with MMSE scores <24. The 5-year survival rates were 60.6%, 40.9%, and 22.6% in the normal, MCI and suspected dementia groups, respectively. With some exceptions, MMSE results tended to decline during the observation period. A multivariate Cox proportional hazards model showed that age (hazard ratio [HR], 1.04; P = 0.007), dialysis vintage (HR, 0.96; P = 0.04), male sex (HR, 1.77; P = 0.02), geriatric nutritional risk index (HR, 0.94; P < 0.001) and MMSE score (HR, 0.96; P = 0.01) were independent risk factors for patient survival. CONCLUSIONS Cognitive impairment in patients undergoing hemodialysis was associated with age and nutritional status. Patients with cognitive impairment had a poor prognosis. Geriatr Gerontol Int 2023; 23: 111-116.
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Affiliation(s)
| | - Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Akira Tamaki
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideyuki Tomura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosei Yamaguchi
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kostoff RN, Briggs MB, Kanduc D, Dewanjee S, Kandimalla R, Shoenfeld Y, Porter AL, Tsatsakis A. Modifiable contributing factors to COVID-19: A comprehensive review. Food Chem Toxicol 2023; 171:113511. [PMID: 36450305 PMCID: PMC9701571 DOI: 10.1016/j.fct.2022.113511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
The devastating complications of coronavirus disease 2019 (COVID-19) result from an individual's dysfunctional immune response following the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Multiple toxic stressors and behaviors contribute to underlying immune system dysfunction. SARS-CoV-2 exploits the dysfunctional immune system to trigger a chain of events ultimately leading to COVID-19. The current study identifies eighty immune system dysfunction-enabling toxic stressors and behaviors (hereafter called modifiable contributing factors (CFs)) that also link directly to COVID-19. Each CF is assigned to one of the five categories in the CF taxonomy shown in Section 3.3.: Lifestyle (e.g., diet, substance abuse); Iatrogenic (e.g., drugs, surgery); Biotoxins (e.g., micro-organisms, mycotoxins); Occupational/Environmental (e.g., heavy metals, pesticides); Psychosocial/Socioeconomic (e.g., chronic stress, lower education). The current study shows how each modifiable factor contributes to decreased immune system capability, increased inflammation and coagulation, and increased neural damage and neurodegeneration. It is unclear how real progress can be made in combatting COVID-19 and other similar diseases caused by viral variants without addressing and eliminating these modifiable CFs.
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Affiliation(s)
- Ronald Neil Kostoff
- Independent Consultant, Gainesville, VA, 20155, USA,Corresponding author. Independent Consultant, 13500 Tallyrand Way, Gainesville, VA, 20155, USA
| | | | - Darja Kanduc
- Dept. of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Via Orabona 4, Bari, 70125, Italy
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, 500007, Telangana, India
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, 5265601, Israel
| | - Alan L. Porter
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece
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27
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Sedaghat S, Ji Y, Hughes TM, Coresh J, Grams ME, Folsom AR, Sullivan KJ, Murray AM, Gottesman RF, Mosley TH, Lutsey PL. The Association of Kidney Function with Plasma Amyloid-β Levels and Brain Amyloid Deposition. J Alzheimers Dis 2023; 92:229-239. [PMID: 36710673 PMCID: PMC10124796 DOI: 10.3233/jad-220765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Reduced kidney function is related to brain atrophy and higher risk of dementia. It is not known whether kidney impairment is associated with higher levels of circulating amyloid-β and brain amyloid-β deposition, which could contribute to elevated risk of dementia. OBJECTIVE To investigate whether kidney impairment is associated with higher levels of circulating amyloid-β and brain amyloid-β deposition. METHODS This cross-sectional study was performed within the community-based Atherosclerosis Risk in Communities (ARIC) Study cohort. We used estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C levels and urine albumin-to-creatinine ratio (ACR) to assess kidney function. Amyloid positivity was defined as a standardized uptake value ratios > 1.2 measured with florbetapir positron emission tomography (PET) (n = 340). Plasma amyloid-β1 - 40 and amyloid-β1 - 42 were measured using a fluorimetric bead-based immunoassay (n = 2,569). RESULTS Independent of demographic and cardiovascular risk factors, a doubling of ACR was associated with 1.10 (95% CI: 1.01,1.20) higher odds of brain amyloid positivity, but not eGFR (odds ratio per 15 ml/min/1.73 m2 lower eGFR: 1.08; 95% CI: 0.95,1.23). A doubling of ACR was associated with a higher level of plasma amyloid-β1 - 40 (standardized difference: 0.12; 95% CI: 0.09,0.14) and higher plasma amyloid-β1 - 42 (0.08; 95% CI: 0.05,0.10). Lower eGFR was associated with higher plasma amyloid-β1 - 40 (0.36; 95% CI: 0.33,0.39) and higher amyloid-β1 - 42 (0.32; 95% CI: 0.29,0.35). CONCLUSION Low clearance of amyloid-β and elevated brain amyloid positivity may link impaired kidney function with elevated risk of dementia. kidney function should be considered in interpreting amyloid biomarker results in clinical and research setting.
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Affiliation(s)
- Sanaz Sedaghat
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Yuekai Ji
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Kevin J Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Anne M Murray
- Department of Medicine, Geriatrics Division, Hennepin HealthCare, and Hennepin HealthCare Institute, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, Maryland
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Wang S, Wang J, Dove A, Guo J, Yang W, Qi X, Bennett DA, Xu W. Association of impaired kidney function with dementia and brain pathologies: A community-based cohort study. Alzheimers Dement 2022. [PMID: 36571791 DOI: 10.1002/alz.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The relationship between impaired kidney function (KF), dementia, and brain pathologies remains unclear. METHODS A total of 1354 dementia- and kidney disease-free participants including 895 with normal and 459 with impaired KF were followed from 2002 until 2020 (median [interquartile range]: 5 [2-9]) to detect incident dementia. KF was assessed at baseline and categorized as normal or impaired. Over the follow-up, 453 participants died and underwent autopsies for neuropathological assessment. RESULTS Compared to those with normal KF, the hazard ratios (95% confidence intervals [CIs]) of those with impaired KF was 1.48 (1.15, 1.90)/1.44 (1.10, 1.88) for dementia/Alzheimer's dementia. Furthermore, impaired KF was related to a significantly higher burden of cerebral amyloid angiopathy (CAA; odds ratio = 1.96, 95% CI: 1.17, 3.30), but not to other brain pathologies. DISCUSSION Impaired KF is associated with an increased risk of dementia and Alzheimer's dementia. CAA may underlie, in part, this association. HIGHLIGHTS Impaired kidney function (KF) was associated with higher dementia and Alzheimer's dementia risk. Impaired KF anticipated dementia and Alzheimer's dementia onset by more than 1.5 years. Impaired KF was significantly related to a higher burden of cerebral amyloid angiopathy (CAA) but not to other brain pathologies.
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Affiliation(s)
- Shuqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
| | - Jiao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
| | - Abigail Dove
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jie Guo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Feng L, Wu D, Ping P, Lin J, Zhao Y, Yao Y, Zhang P, Fu S. Age Related Cognitive Function Was Positively Associated with Diastolic Pressure and Negatively Associated with Antibody Expression in Chinese Oldest-Old and Centenarian Adults. J Inflamm Res 2022; 15:6675-6682. [DOI: 10.2147/jir.s344105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/16/2022] [Indexed: 12/14/2022] Open
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30
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Chan FHF, Newman S, Khan BA, Griva K. The role of subjective cognitive complaints in self-management among haemodialysis patients: a cross-sectional study. BMC Nephrol 2022; 23:363. [PMID: 36376848 PMCID: PMC9661809 DOI: 10.1186/s12882-022-02994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Subjective cognitive complaints refer to self-experienced difficulties with everyday cognitive tasks. Although there has been a fair amount of research on cognitive impairments and cognitive complaints in end-stage renal disease, the practical implications of these complaints remain unclear. The current study aims to examine the associations of cognitive complaints with sociodemographic and clinical variables, mood, as well as key patient-reported outcomes, i.e., self-efficacy, self-management skills, and treatment adherence. Methods A total of 305 haemodialysis patients (mean age = 53.97 years, 42.6% female) completed the Kidney Disease Quality of Life Cognitive Function subscale, a brief measure of cognitive complaints. The recommended cut-off point of 60 was used to identify probable cognitive impairment. Measures of self-efficacy, self-management skills (i.e., symptom coping, health monitoring, health service navigation), treatment adherence, and mood symptoms were also administered. Between-group comparisons and correlational analyses were performed to examine associations of cognitive complaints with sociodemographic, clinical, and health behaviour variables. Mediation analyses were also conducted to investigate the mediating role of self-efficacy on the relationship between cognitive complaints and treatment adherence. Results Nearly a quarter (23.0%) of haemodialysis patients reported cognitive complaints indicative of clinical impairments. Risk of probable impairments was higher for patients with hypertension, diabetes, those diagnosed with end-stage renal disease at an older age, and those with shorter time on dialysis. Subjective cognitive complaints (both rates of probable impairments as per cut-off and continuous scores) were significantly associated with lower disease and treatment self-efficacy, poorer self-management skills, lower treatment adherence, as well as higher symptoms of distress. Mediation analysis indicated that treatment self-efficacy mediated the relationship between cognitive complaints and treatment adherence. Conclusions The current study demonstrated the clinical characteristics of haemodialysis patients who report cognitive complaints indicative of probable cognitive impairments and showed the associations of these complaints with self-management outcomes. Future studies should adopt more comprehensive measures of cognitive complaints and longitudinal designs to confirm the current findings.
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31
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Mathur A, Ahn JB, Sutton W, Chu NM, Gross AL, Segev DL, McAdams-DeMarco M. Secondary hyperparathyroidism (CKD-MBD) treatment and the risk of dementia. Nephrol Dial Transplant 2022; 37:2111-2118. [PMID: 35512551 PMCID: PMC9585471 DOI: 10.1093/ndt/gfac167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Elevated parathyroid hormone (PTH) levels have been reported as a potential risk factor for cognitive impairment. Compared with the general population, older adults with end-stage renal disease (ESRD) who are frequently affected by secondary hyperparathyroidism (SHPT) are at increased risk of developing dementia. The main objective of our study was to evaluate if the risk of dementia in older (age ≥66 years) ESRD patients differed if they were treated for SHPT. METHODS Using the United States Renal Data System and Medicare claims, we identified 189 433 older adults without a diagnosis of dementia, who initiated dialysis between 2006 and 2016. SHPT treatment was defined as the use of vitamin D analogs, phosphate binders, calcimimetics or parathyroidectomy. We quantified the association between treated SHPT and incident dementia during dialysis using a multivariable Cox proportional hazards model with inverse probability weighting, considering SHPT treatment as a time-varying exposure. RESULTS Of 189 433 older ESRD adults, 92% had a claims diagnosis code of SHPT and 123 388 (65%) were treated for SHPT. The rate of incident dementia was 6 cases per 100 person-years among SHPT treated patients compared with 11 cases per 100 person-years among untreated patients. Compared with untreated SHPT patients, the risk of dementia was 42% lower [adjusted hazard ratio (aHR) = 0.58, 95% confidence interval (CI): 0.56-0.59] among SHPT treated patients. The magnitude of the beneficial effect of SHPT treatment differed by sex (Pinteraction = .02) and race (Pinteraction ≤ .01), with females (aHR = 0.56, 95% CI: 0.54-0.58) and those of Asian (aHR = 0.51, 95% CI: 0.46-0.57) or Black race (aHR = 0.51, 95% CI: 0.48-0.53) having a greatest reduction in dementia risk. CONCLUSION Receiving treatment for SHPT was associated with a lower risk of incident dementia among older patients with ESRD. This work provides additional support for the treatment of SHPT in older ESRD patients.
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Affiliation(s)
- Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - JiYoon B Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Whitney Sutton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, New York University Langone Health, NY, NY, USA
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Bogataj Š, Mesarič KK, Pajek M, Petrušič T, Pajek J. Physical exercise and cognitive training interventions to improve cognition in hemodialysis patients: A systematic review. Front Public Health 2022; 10:1032076. [PMID: 36311587 PMCID: PMC9616536 DOI: 10.3389/fpubh.2022.1032076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction Patients with chronic kidney disease treated with hemodialysis (HD) have lower cognitive abilities compared to the age-matched healthy population. Recently, physical exercise and cognitive training have been presented as possible interventions to improve cognitive abilities both in the general population and in patients with chronic diseases. To date, there is no general overview of the current knowledge on how these interventions affect cognitive abilities in HD patients and what tests are used to measure these effects. Methods Three electronic databases were searched for randomized controlled studies of physical exercise or cognitive training interventions that examined effects on cognitive abilities/performance in HD patients. Results Six articles were included. All included studies used physical exercise as an intervention, with one study also including tablet-based cognitive training. Four studies included an intradialytic approach and two included a home-based intervention. Intervention lasted. A significant intervention effect was observed in three studies compared with the control condition. Conclusion The present review suggests that physical exercise might improve or at least not worsen cognitive performance in HD patients, whereas the effect of cognitive training has not yet been adequately studied. There is a need for more sensitive and specific cognitive tests to adequately measure the effects of interventions in the HD population.
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Affiliation(s)
- Špela Bogataj
- Department of Nephrology, University Medical Centre Ljubljanag, Ljubljana, Slovenia,*Correspondence: Špela Bogataj
| | - Katja Kurnik Mesarič
- Department of Nephrology, University Medical Centre Ljubljanag, Ljubljana, Slovenia
| | - Maja Pajek
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Petrušič
- Faculty of Education, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Pajek
- Department of Nephrology, University Medical Centre Ljubljanag, Ljubljana, Slovenia
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Silva O, Jaber D, Chiu A, Adams-Mardi C, Wicht E. Depression and Capacity to Withdraw from Dialysis. THE JOURNAL OF CLINICAL ETHICS 2022. [DOI: 10.1086/jce2022333240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ahoui S, Vigan J, Agbetou M, Agboton LB, Ahonon BM, Eteka E, Adoukonou TA. Neuropathies périphériques et facteurs associés chez les hémodialysés chroniques du Bénin. Nephrol Ther 2022; 18:512-517. [DOI: 10.1016/j.nephro.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 02/05/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022]
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Tariq H, Ramakrishnan M, Gupta A. Insights into Cognitive Brain Health in Chronic Kidney Disease. GERONTOLOGY & GERIATRICS : RESEARCH 2022; 8:1074. [PMID: 37671071 PMCID: PMC10478617 DOI: 10.26420/gerontolgeriatrres.2022.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Cognitive impairment and Chronic Kidney Disease (CKD) are common in older adults. With advances in medicine, the average lifespan is expected to increase, further increasing the prevalence of both conditions. The mechanisms underlying cognitive impairment in CKD are unclear. While mild-moderately low estimated glomerular filtration rate (eGFR) may not be associated with cognitive impairment, severely decreased eGFR and albuminuria do. Patients on dialysis have a high prevalence of cognitive impairment. Cognitive function improves after kidney transplantation. However, some residual cognitive deficits persist after transplantation, indicating that restoring the kidney function alone may not be enough to restore cognitive function, and other etiological factors may play a role. Albuminuria, another marker of CKD is also associated with cognitive impairment. However, albuminuria is often undiagnosed. Improving early identification and management of patients with albuminuria may be a good population-based dementia prevention strategy. Other factors associated with cognitive impairment in CKD include anemia and other metabolic derangements commonly observed in CKD. In this article, we reviewed the prevalence of cognitive impairment in CKD, the potential mechanisms underlying cognitive impairment in CKD, andthecurrent evidence on the association between cognitive impairment and eGFR and albuminuria.
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Affiliation(s)
- H Tariq
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - M Ramakrishnan
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - A Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
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Malik R, Kalra S, Bhatia S, Harrasi AA, Singh G, Mohan S, Makeen HA, Albratty M, Meraya A, Bahar B, Tambuwala MM. Overview of therapeutic targets in management of dementia. Biomed Pharmacother 2022; 152:113168. [PMID: 35701303 DOI: 10.1016/j.biopha.2022.113168] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia is defined as a gradual cognitive impairment that interferes with everyday tasks, and is a leading cause of dependency, disability, and mortality. According to the current scenario, millions of individuals worldwide have dementia. This review provides with an overview of dementia before moving on to its subtypes (neurodegenerative and non-neurodegenerative) and pathophysiology. It also discusses the incidence and severity of dementia, focusing on Alzheimer's disease with its different hypotheses such as Aβ cascade hypothesis, Tau hypothesis, inflammatory hypothesis, cholinergic and oxidative stress hypothesis. Alzheimer's disease is the most common type and a progressive neurodegenerative illness distinct by neuronal loss and resulting cognitive impairment, leading to dementia. Alzheimer's disease (AD) is considered the most familiar neurodegenerative dementias that affect mostly older population. There are still no disease-modifying therapies available for any dementias at this time, but there are various methods for lowering the risk to dementia patients by using suitable diagnostic and evaluation methods. Thereafter, the management and treatment of primary risk elements of dementia are reviewed. Finally, the future perspectives of dementia (AD) focusing on the impact of the new treatment are discussed.
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Affiliation(s)
- Rohit Malik
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, Haryana, India
| | - Sunishtha Kalra
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, Haryana, India
| | - Saurabh Bhatia
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India; Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mauz, Oman
| | - Ahmed Al Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mauz, Oman
| | - Govind Singh
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, Haryana, India.
| | - Syam Mohan
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India; Substance Abuse and Toxicology Research Centre, Jazan University, Jazan, Saudi Arabia
| | - Hafiz A Makeen
- Pharmacy Practice Research Unit, Clinical Pharmacy Department, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Albratty
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Abdulkarim Meraya
- Substance Abuse and Toxicology Research Centre, Jazan University, Jazan, Saudi Arabia
| | - Bojlul Bahar
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport & Health Sciences, University of Central Lancashire, Preston, UK
| | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Science, Ulster University, Coleraine, UK.
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Kelly DM, Anderson CD, Blacker D, Miller BL, Viswanathan A. Editorial: The impact of chronic kidney disease on cognitive brain health. Front Neurol 2022; 13:982740. [PMID: 35968308 PMCID: PMC9363240 DOI: 10.3389/fneur.2022.982740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dearbhla M. Kelly
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, United States
- *Correspondence: Dearbhla M. Kelly
| | - Christopher D. Anderson
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Bruce L. Miller
- Department of Neurology, UCSF Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Anand Viswanathan
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Chen JB, Chang CC, Moi SH, Li LC. A Profile of Nanoparticle-Based Plasma Neurodegenerative Biomarkers for Cognitive Function Among Patients Undergoing Hemodialysis. Int J Gen Med 2022; 15:6115-6125. [PMID: 35846795 PMCID: PMC9286482 DOI: 10.2147/ijgm.s368987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/05/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aimed to compare the plasma levels of nanoparticle-based neurodegenerative biomarkers between hemodialysis (HD) participants with grossly normal cognitive function and healthy controls. Patients and Methods A cohort of participants undergoing maintenance HD and healthy controls were enrolled for comparison between July and October 2021. The immunomagnetic reduction method was used to measure plasma neurodegenerative biomarkers Aβ1-40, Aβ1-42, tau protein, and neurofilament light chain (NfL). The clinical dementia rating (CDR) was used to evaluate cognitive function. A receiver operating characteristic curve was used to discriminate between HD participants and healthy controls. Results There were 52 and 18 participants in the HD and healthy control groups, respectively. The mean age of the HD participants was 62 years, and that of the healthy controls was 57 years. The mean HD vintage in the HD cohort was 11.8 years. HD participants demonstrated significantly higher plasma levels of Aβ1-42, tau protein, Aβ1-42 × tau, and NfL and Aβ1-42/Aβ1-40 ratio and significantly lower plasma Aβ1-40 levels than healthy controls. The measured plasma biomarkers could not discriminate between CDR0 and CDR0.5 HD participants. The area under the curve of the study biomarkers to discriminate HD participants from healthy controls ranged from 0.987 (Aβ1-42 × tau) to 0.889 (NfL). Conclusion The plasma levels of nanoparticle-based neurodegenerative biomarkers were higher in HD participants with grossly normal cognitive function than in healthy controls. These findings imply that neurodegenerative changes appear in HD participants. A profile of plasma neurodegenerative biomarkers could be considered a potential surrogate for evaluating long-term cognitive function in HD participants.
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Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Kaohsiung, 833, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, 330, Taiwan, Republic of China
| | - Chiung-Chih Chang
- College of Medicine, Chang Gung University, Taoyuan, 330, Taiwan, Republic of China.,Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Kaohsiung, 833, Taiwan, Republic of China
| | - Sin-Hua Moi
- Center of Cancer Program Development, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 833, Taiwan, Republic of China
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Kaohsiung, 833, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, 330, Taiwan, Republic of China
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Ohdo S, Koyanagi S, Matsunaga N. Chronopharmacology of immune-related diseases. Allergol Int 2022; 71:437-447. [PMID: 35850747 DOI: 10.1016/j.alit.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022] Open
Abstract
Clock genes, circadian pacemaker resides in the paired suprachiasmatic nuclei (SCN), control various circadian rhythms in many biological processes such as physiology and behavior. Clock gene regulates many diseases such as cancer, immunological dysfunction, metabolic syndrome and sleep disorders etc. Chronotherapy is especially relevant, when the risk and/or intensity of the symptoms of disease vary predicably over time as exemplified by allergic rhinitis, arthritis, asthma, myocardial infarction, congestive heart failure, stroke, and peptic ulcer disease. Dosing time influences the effectiveness and toxicity of many drugs. The pharmacodynamics of medications as well as pharmacokinetics influences chronopharmacological phenomena. To escape from host immunity in the tumor microenvironment, cancer cells have acquired several pathways. Immune checkpoint therapy targeting programmed death 1 (PD-1) and its ligand (PD-L1) interaction had been approved for the treatment of patients with several types of cancers. Circadian expression of PD-1 is identified on tumor associated macrophages (TAMs), which is rationale for selecting the most appropriate time of day for administration of PD-1/PD-L1 inhibitors. The therapies for chronic kidney disease (CKD) are urgently needed because of a global health problem. The mechanism of the cardiac complications in mice with CKD had been related the GRP68 in circulating monocytes and serum accumulation of retinol. Development of a strategy to suppress retinol accumulation will be useful to prevent the cardiac complications of CKD. Therefore, we introduce an overview of the dosing time-dependent changes in therapeutic outcome and safety of drug for immune-related diseases.
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Affiliation(s)
- Shigehiro Ohdo
- Department of Pharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.
| | - Satoru Koyanagi
- Department of Glocal Healthcare, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoya Matsunaga
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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Alzahrani AMA. Prevalence of Non-adherence to Prescribed Medications among Hemodialysis Patients in Makkah City. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:526-534. [PMID: 37929545 DOI: 10.4103/1319-2442.388187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Patients with end-stage kidney disease (ESKD) are required to take multiple medications. Adherence to a complex regimen of medications is challenging and might lead to non-adherence. This study aimed to assess nonadherence to prescribed medications among patients with ESKD in Makkah City and determine the factors associated with a such behavior. A cross-sectional study was conducted at three governmental hospitals in Makkah City, Saudi Arabia. Descriptive statistics were performed to characterize participants, and a multivariable logistic regression analysis was used to determine factors associated with nonadherence to prescribed medications among patients with ESKD. In total, 358 patients have submitted completed surveys and were included in this study. A considerable number (45.25%) of participating patients were found to be nonadherent to prescribed medications. The factors: age, belief that taking medications as scheduled is important, adherence to dialysis sessions, and the number of comorbid diseases had significant and negative associations with nonadherence to prescribed medications. On the other hand, the factors: forgetfulness and having depression were significantly and positively associated with non-adherence to prescribed medications. Non-adherence to medications among patients on hemodialysis is a significant issue that leads to life-threatening complications. The factors identified as being significantly associated with nonadherence should be considered in designing future interventions to improve adherence to medications.
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Affiliation(s)
- Ali Mohammed A Alzahrani
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
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Copur S, Berkkan M, Sarafidis P, Kanbay M. Intensive blood pressure control on dementia in patients with chronic kidney disease: Potential reduction in disease burden. Eur J Intern Med 2022; 101:8-13. [PMID: 35465970 DOI: 10.1016/j.ejim.2022.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease (CKD) and dementia are both common comorbidities creating considerable morbidity and mortality, especially in the elderly population with potential interactions. Even though various hypothetical mechanisms underlying the pathophysiology of increased risk of dementia and cognitive impairment in CKD patients have been implicated, no consensus has been reached so far. Recent clinical trials have investigated the therapeutic role of intensive blood pressure control on the risk of dementia in CKD patients with potentially improved outcomes. However, such trials have significant limitations that may influence the outcome and lack specific management guidelines. We reviewed the role of blood pressure and other factors on the risk of dementia in CKD patients which is an issue with high potential for clinical implications that may improve morbidity, mortality, and health expenditures along with its' potential pathophysiological mechanisms and future guidance.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Metehan Berkkan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
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Jiang S, Fuentes-Lemus E, Davies MJ. Oxidant-mediated modification and cross-linking of beta-2-microglobulin. Free Radic Biol Med 2022; 187:59-71. [PMID: 35609861 DOI: 10.1016/j.freeradbiomed.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Beta-2-microglobulin (B2M) is synthesized by all nucleated cells and forms part of the major histocompatibility complex (MHC) class-1 present on cell surfaces, which presents peptide fragments to cytotoxic CD8+ T-lymphocytes, or by association with CD1, antigenic lipids to natural killer T-cells. Knockout of B2M results in loss of these functions and severe combined immunodeficiency. Plasma levels of this protein are low in healthy serum, but are elevated up to 50-fold in some pathologies including chronic kidney disease and multiple myeloma, where it has both diagnostic and prognostic value. High levels of the protein are associated with amyloid formation, with such deposits containing significant levels of modified or truncated protein. In the current study we examine the chemical and structural changes induced of B2M generated by both inflammatory oxidants (HOCl and ONOOH), and photo-oxidation (1O2) which is linked with immunosuppression. Oxidation results in oligomer formation, with this occurring most readily with HOCl and 1O2, and a loss of native protein conformation. LC-MS analysis provided evidence for nitrated (from ONOOH), chlorinated (from HOCl) and oxidized residues (all oxidants) with damage detected at Tyr, Trp, and Met residues, together with cleavage of the disulfide (cystine) bond. An intermolecular di-tyrosine crosslink is also formed between Tyr10 and Tyr63. The pattern of these modifications is oxidant specific, with ONOOH inducing a greater range of modifications than HOCl. Comparison of the sites of modification with regions identified as amyloidogenic indicate significant co-localization, consistent with the hypothesis that oxidation may contribute, and predispose B2M, to amyloid formation.
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Affiliation(s)
- Shuwen Jiang
- Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Eduardo Fuentes-Lemus
- Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Michael J Davies
- Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, 2200, Denmark.
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Zhou GJ, Tang YY, Zuo JX, Yi T, Tang JP, Zhang P, Zou W, Tang XQ. Itaconate alleviates β 2-microglobulin-induced cognitive impairment by enhancing the hippocampal amino-β-carboxymuconate-semialdehyde-decarboxylase/picolinic acid pathway. Biochem Pharmacol 2022; 202:115137. [PMID: 35700758 DOI: 10.1016/j.bcp.2022.115137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/20/2022]
Abstract
β2-microglobulin (B2M) has been established to impair cognitive function. However, no treatment is currently available for B2M-induced cognitive dysfunction. Itaconate is a tricarboxylic acid (TCA) cycle intermediate that exerts neuroprotective effects in several neurological diseases. The amino-β-carboxymuconate-semialdehyde-decarboxylase (ACMSD)/picolinic acid (PIC) pathway is a crucial neuroprotective branch in the kynurenine pathway (KP). The present study sought to investigate whether Itaconate attenuates B2M-induced cognitive impairment and examine the mediatory role of the hippocampal ACMSD/PIC pathway. We demonstrated that 4-Octyl Itaconate (OI, an itaconate derivative) significantly alleviated B2M-induced cognitive dysfunction and hippocampal neurogenesis impairment. OI treatment also increased the expression of ACMSD, elevated the concentration of PIC, and decreased the level of 3-HAA in the hippocampus of B2M-exposed rats. Furthermore, inhibition of ACMSD by TES-991 significantly abolished the protections of Itaconate against B2M-induced cognitive impairment and neurogenesis deficits. Exogenous PIC supplementation in hippocampus also improved cognitive performance and hippocampal neurogenesis in B2M-exposed rats. These findings demonstrated that Itaconate alleviates B2M-induced cognitive impairment by upregulation of the hippocampal ACMSD/PIC pathway. This is the first study to document Itaconate as a promising therapeutic agent to ameliorate cognitive impairment. Moreover, the mechanistic insights into the ACMSD/PIC pathway improve our understanding of it as a potential therapeutic target for neurological diseases beyond B2M-associated neurocognitive disorders.
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Affiliation(s)
- Gui-Juan Zhou
- The First Affiliated Hospital, Institute of Neurology, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China; Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Institute of Neuroscience, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China
| | - Yi-Yun Tang
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Institute of Neuroscience, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China
| | - Jin-Xi Zuo
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Institute of Neuroscience, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China; The Affiliated Nanhua Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, PR China
| | - Tao Yi
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Institute of Neuroscience, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China; The Affiliated Nanhua Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, PR China
| | - Jun-Peng Tang
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Institute of Neuroscience, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China; The Affiliated Nanhua Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, PR China
| | - Ping Zhang
- The Affiliated Nanhua Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, PR China
| | - Wei Zou
- The Affiliated Nanhua Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, PR China.
| | - Xiao-Qing Tang
- The First Affiliated Hospital, Institute of Neurology, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China; Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Institute of Neuroscience, Hengyang Medical School, University of South China, Hengyang 42100, Hunan, PR China.
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Butcher E, Walker R, Wyeth E, Samaranayaka A, Schollum J, Derrett S. Health-Related Quality of Life and Disability Among Older New Zealanders With Kidney Failure: A Prospective Study. Can J Kidney Health Dis 2022; 9:20543581221094712. [PMID: 35493402 PMCID: PMC9052826 DOI: 10.1177/20543581221094712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Disability is prevalent in individuals with kidney failure and can contribute
to significantly reduced quality of life and survival. In older individuals
with kidney failure, disability can be caused by a combination of factors,
including issues directly related to their kidney disease and/or treatment,
including weakness, low energy, and low activity. Few studies have
investigated health-related quality of life (HRQoL) as a possible predictor
of disability among older individuals experiencing kidney failure. Objective: This study aimed to determine if patient-reported HRQoL, and/or other factors
at baseline, predicts disability in people with kidney failure, aged ≥65
years, after 12 months of follow-up. Design: The DOS65+ study was an accelerated longitudinal cohort design comprising of
both cross-sectional and longitudinal components. Participants were eligible
if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD 5G)
(estimated glomerular filtration rate (eGFR) <15 ml/min/1.73
m2), and had: commenced kidney replacement education, or were
on an active conservative pathway, or were newly incident dialysis patients
commencing dialysis therapy or prevalent on dialysis. Setting: Three New Zealand District Health Board (DHB) nephrology units (Counties
Manukau, Hawke’s Bay, and Southern DHB) were involved in the study. Participants: Participants were eligible if they were aged ≥65 years, had CKD 5G (eGFR
<15 ml/min/1.73 m2), and had: commenced kidney replacement
education, or were on an active conservative pathway, or were newly incident
dialysis patients commencing dialysis therapy or prevalent on dialysis. Measurements: Disability and HRQoL were measured by EQ-5D-3L, a WHO Disability Assessment
Schedule (WHODAS) 2.0. Methods: Baseline and 12-month data from our longitudinal dialysis outcomes in older
New Zealanders’ study were analyzed to determine if HRQoL at baseline
predicted disability outcomes 12 months later. Results: Of the 223 participants at baseline, 157 participants completed a follow-up
interview 12 months later. Individuals with “considerable disability” at
baseline had a significantly (86%) higher risk of experiencing “considerable
disability” at 12 months compared with those with “lesser/no disability” at
baseline. Two thirds of those with ≥3 comorbidities were experiencing
“considerable disability.” In addition, those with problems with EQ-5D-3L
self-care, EQ-5D-3L usual activities, and EQ-5D-3L anxiety/depression
reported higher rates of disability. Limitations: Selection bias is likely to have been an issue in this study as participants
were excluded from the follow-up interview if they had an intercurrent
illness requiring hospitalization within 2 weeks of the survey interview or
if the treating nephrologist judged that the individual’s ability to take
part was significantly impaired. Sample size meant there were a limited
number of explanatory/confounding variables that could be investigated in
the multivariable model. Conclusions: EQ-5D-3L mobility and self-care may be useful in predicting subsequent
disability for individuals with CKD 5G. Although individuals with kidney
failure often experience disability, previous studies have not clearly
identified HRQoL or disability as predictors of later disability for
individuals with kidney failure. Therefore, we would recommend the
assessment of mobility and self-care, in conjunction with existing
disabilities in the clinical review and pre-dialysis education of
individuals with kidney failure as they approach the need for kidney
replacement therapy. Trial registration: the Australian and New Zealand clinical trials registry:
ACTRN12611000024943.
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Affiliation(s)
- Elizabeth Butcher
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - John Schollum
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Saad MA, Abo-Raya SN, Waly MA, Saad NL. Association of Serum Levels of Cystatin C and Cognition in a Cohort of Egyptian Elderly Patients with Chronic Kidney Disease. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:288-295. [PMID: 37417181 DOI: 10.4103/1319-2442.379027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Chronic kidney disease (CKD) and dementia are common morbidities of elders. Serum cystatin C has been suggested to be an ideal marker for kidney function. The current study aimed to detect the serum levels of cystatin C in CKD patients and to correlate these levels to cognitive performance. The study involved 90 subjects aged 65 years and more, divided into two groups: Group 1: 60 patients with CKD, and Group 2: 30 control participants. Exclusion criteria included cardiac failure, hepatic failure, thyroid diseases, dialysis for more than one month, polycystic kidney disease, organ transplantation, and immunosuppressive therapy within the past six months. All participants had routine laboratory workup, serum cystatin C using enzyme-linked immunosorbent assay kits, and cognitive assessment using mini-mental state examination (MMSE). Serum cystatin level was significantly high in CKD patients while MMSE scores were significantly lower in CKD patients. A high significant negative correlation was found between serum cystatin C levels and both degree of cognitive impairment and glomerular filtration rate (GFR). Also, a significant positive correlation was found between the degree of cognitive impairment and GFR levels. Serum cystatin levels are significantly associated with cognitive impairment in CKD patients, and this correlation becomes more evident with the worsening of CKD stages. That may help in better understanding of the pathogenesis of dementia in CKD patients with the emergence of therapeutic options depending on these data.
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Affiliation(s)
- Marwa A Saad
- Department of Internal Medicine, Geriatric Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Suzan N Abo-Raya
- Department of Internal Medicine, Geriatric Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Marwa A Waly
- Department of Nephrology, Shark El-Madinah Hospital, Alexandria, Egypt
| | - Neveen L Saad
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Su H, Fu S, Liu M, Yin Y, Hua K, Meng S, Jiang G, Quan X. Altered Spontaneous Brain Activity and Functional Integration in Hemodialysis Patients With End-Stage Renal Disease. Front Neurol 2022; 12:801336. [PMID: 35222228 PMCID: PMC8863739 DOI: 10.3389/fneur.2021.801336] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Using the amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) algorithm to study the alteration of brain function in hemodialysis patients with end-stage renal disease (ESRD). Patients and Methods We recruited 20 patients with ESRD on regular hemodialysis and 17 healthy controls (HCs). All of the participants underwent resting-state fMRI (rs-fMRI), neuropsychological tests, and blood biochemical examination. The individual ALFF values between the two groups were tested by an independent sample t-test. Then, we set the altered ALFF brain areas as seed regions of interest (ROIs), and FC analysis was used to investigate the functional integration patterns between the seed ROI and the voxels within the whole brain. Results The ALFF values of the right precuneus and angular gyrus (RAG) in the ESRD group were lower than those in the HC subjects, but the right precentral gyrus showed higher ALFF values in patients. Hemoglobin (Hb) was negatively correlated with the ALFF values of the right precentral gyrus, and the ALFF values of the right precuneus were negatively correlated with line-tracing test (LTT) scores in patients with ESRD. Patients with ESRD show decreased connectivity between the RAG and the left precuneus, right superior frontal gyrus (RSFG), and the connectivity within the RAG was weak. In addition, FC in the RAG-right cuneus, right precuneus-left supramarginal gyrus was enhanced in the patient group. Conclusion Our research suggested that, in hemodialysis patients with ESRD, the brain areas with abnormal spontaneous brain activity and FC are mainly located in the default mode network (DMN) regions. Hb and the LTT results were correlated with abnormal spontaneous brain activity. These findings provide additional evidence to understand the possible underlying neuropathological mechanisms in patients with ESRD.
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Affiliation(s)
- Huanhuan Su
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shishun Fu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Mengchen Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Kelei Hua
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shandong Meng
- Department of Organ Transplantation, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
- Guihua Jiang
| | - Xianyue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Xianyue Quan
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Sodium hydrosulfide reverses β 2-microglobulin-induced depressive-like behaviors of male Sprague-Dawley rats: Involving improvement of synaptic plasticity and enhancement of Warburg effect in hippocampus. Behav Brain Res 2022; 417:113562. [PMID: 34499939 DOI: 10.1016/j.bbr.2021.113562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/03/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Our previous works demonstrated that β2-microglobulin (β2m), a systemic pro-aging factor, induce depressive-like behaviors. Hydrogen sulfide (H2S) is identified as a potential target for treatment of depression. The aim of the present work is to explore whether H2S antagonizes β2m-induced depressive-like behaviors and the underlying mechanisms. METHODS The depressive-like behaviors were detected using the novelty suppressed feeding test (NSFT), tail suspension test (TST), forced swimming test (FST) and open field test (OFT). The expressions of Warburg-related proteins, including hexokinase II (HK II), pyruvate kinase M2 (PKM2), Lactate dehydrogenase A (LDHA), pyruvate dehydrogenase (PDH) and pyruvate dehydrogenase kinase 1(PDK1), and synaptic plasticity-related proteins, including postsynaptic density protein 95 (PSD95) and synaptophysin1 (SYN1), were determined by western blotting. RESULT we found that NaHS (the donor of H2S) attenuated the depressive-like behaviors in the β2m-exposed rats, as judged by NSFT, TST, FST, and OFT. We also demonstrated that NaHS enhanced the synaptic plasticity, as evidenced by the upregulations of PSD95 and SYN1 expressions in the hippocampus of β2m-exposed rats. Furthermore, NaHS improved the Warburg effect in the hippocampus of β2m-exposed rats, as evidenced by the upregulations of HK II, PKM2, LDHA and PDK1 expressions, and the downregulation of PDH expression. CONCLUSION H2S prevents β2m-induced depressive-like behaviors, which is involved in improvement of hippocampal synaptic plasticity as a result of enhancement of hippocampal Warburg effect.
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Zheng Y, Ji B, Chen S, Zhou R, Ni R. The impact of uremic toxins on Alzheimer's disease. Curr Alzheimer Res 2022; 19:104-118. [PMID: 35048807 DOI: 10.2174/1567205019666220120113305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/27/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022]
Abstract
Alzheimer's disease (AD) is the most common type of dementia, pathologically characterized by accumulation of senile plaques and neurofibrillary tangles. Chronic kidney disease (CKD) is highly prevalent in elderly population closely associated with occurrence of dementia. Recent epidemiological and experimental studies suggest a potential association of CKD with AD. Both diseases share a panel of identical risk factors, such as type 2 diabetes; and hypertension. However, the relationship between CKD and AD is unclear. Lower clearance of a panel of uremic toxin including cystatin-C, guanidine, and adiponectin due to CKD is implied to contribute to AD pathogenesis. In this review we summarize the current evidence from epidemiological, experimental and clinical studies on the potential contribution of uremic toxins to AD pathogenesis. We describe outstanding questions and propose an outlook on the link between uremic toxins and AD.
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Affiliation(s)
- Yuqi Zheng
- Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bin Ji
- Department of Radiopharmacy and Molecular Imaging, School of Pharmacy, Fudan University, Shanghai, China
| | - Sijun Chen
- Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong Zhou
- Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruiqing Ni
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
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Ertuglu L, Yildiz A, Gamboa J, Ikizler TA. Skeletal muscle energetics in patients with moderate to advanced kidney disease. Kidney Res Clin Pract 2022; 41:14-21. [PMID: 35108768 PMCID: PMC8816417 DOI: 10.23876/j.krcp.21.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022] Open
Abstract
Sarcopenia, defined as decrease in muscle function and mass, is common in patients with moderate to advanced chronic kidney disease (CKD) and is associated with poor clinical outcomes. Muscle mitochondrial dysfunction is proposed as one of the mechanisms underlying sarcopenia. Patients with moderate to advanced CKD have decreased muscle mitochondrial content and oxidative capacity along with suppressed activity of various mitochondrial enzymes such as mitochondrial electron transport chain complexes and pyruvate dehydrogenase, leading to impaired energy production. Other mitochondrial abnormalities found in this population include defective beta-oxidation of fatty acids and mitochondrial DNA mutations. These changes are noticeable from the early stages of CKD and correlate with severity of the disease. Damage induced by uremic toxins, oxidative stress, and systemic inflammation has been implicated in the development of mitochondrial dysfunction in CKD patients. Given that mitochondrial function is an important determinant of physical activity and performance, its modulation is a potential therapeutic target for sarcopenia in patients with kidney disease. Coenzyme Q, nicotinamide, and cardiolipin-targeted peptides have been tested as therapeutic interventions in early studies. Aerobic exercise, a well-established strategy to improve muscle function and mass in healthy adults, is not as effective in patients with advanced kidney disease. This might be due to reduced expression or impaired activation of peroxisome proliferator-activated receptor-gamma coactivator 1α, the master regulator of mitochondrial biogenesis. Further studies are needed to broaden our understanding of the pathogenesis of mitochondrial dysfunction and to develop mitochondrial-targeted therapies for prevention and treatment of sarcopenia in patients with CKD.
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Affiliation(s)
- Lale Ertuglu
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abdulmecit Yildiz
- Division of Nephrology, Department of Medicine, Uludag University, Bursa, Turkey
| | - Jorge Gamboa
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T. Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Health Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Correspondence: T. Alp Ikizler Division of Nephrology, Vanderbilt University Medical Center, 1161 21st Avenue South, S-3223 Medical Center North, Nashville 37232, TN, USA. E-mail:
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Phosphate Dysregulation and Neurocognitive Sequelae. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1362:151-160. [DOI: 10.1007/978-3-030-91623-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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