REVIEW – February 2023

Chronic kidney disease and its effects on the central nervous system

Authors: Triinu Johanna Lume, Jana Uhlinova, Leelo Järv

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Chronic kidney disease (CKD) is an independent risk factor for complications of the central nervous system (CNS). It is well established that CKD is associated with a significantly increased risk of stroke and cognitive impairment. CKD exacerbates
stroke pathogenesis and limits the use of available therapeutic methods for treatment and secondary prevention. As a result, strokes in patients with CKD are often more extensive and fatal than in those without CKD. Patients with CKD also have higher
incidence of other neurological complications such as intracerebral haemorrhage, covert strokes and leukoaraiosis. Thus, it can be concluded that renal dysfunction has serious consequences for the CNS that should not be underestimated, especially given that the prevalence of CKD is increasing worldwide and that stroke is a common cause of death among CKD patients. The higher risk of stroke in CKD patients cannot be explained by the presence of traditional cardiovascular risk factors such as age, sex, smoking, hypertension, diabetes and dyslipidaemia alone. Other factors specific to CKD, such as uremic toxins, disorders of calcium and phosphorus metabolism, oxidative stress, inflammation and receiving treatment with dialysis, have also been shown to play a role. All of these factors damage the blood vessels of the body and contribute to the development of arterio- and atherosclerosis, which in turn increase the risk of developing neurological and cardiovascular complications.