The Contribution of Kidney Disease to Cognitive Impairment in Patients with Type 2 Diabetes
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MICROVASCULAR COMPLICATIONS—NEPHROPATHY (B ROSHANRAVAN, SECTION EDITOR)
The Contribution of Kidney Disease to Cognitive Impairment in Patients with Type 2 Diabetes Shivani Ghoshal 1 & Nicholette D. Allred 2 & Barry I. Freedman 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review focuses on the relationships between diabetes, cognitive impairment, and the contribution of kidney disease. Recent Findings We review the independent contributions of parameters of kidney disease, including albuminuria, glomerular filtration, bone/mineral metabolism, and vitamin D synthesis, on cognitive performance in patients with diabetes. Potential pathophysiologic mechanisms underlying these associations are discussed highlighting gaps in existing knowledge. Finally, effects of the dialysis procedure on the brain and cognitive performance are considered. Emphasis is placed on novel noninvasive screening tools with the potential to preserve cerebral perfusion during hemodialysis and limit cognitive decline in patients with diabetic ESKD. Summary Patients with type 2 diabetes and advanced chronic kidney disease suffer a higher prevalence of cognitive impairment. This is particularly true in patients with diabetes and end-stage kidney disease (ESKD). Keywords Albuminuria . Brain . Chronic kidney disease . Cognition . Diabetes mellitus . Stroke
Introduction Type 2 diabetes (T2D) and chronic kidney disease (CKD) are independent risk factors for cognitive dysfunction. Approximately 43.5% of patients with T2D develop clinically significant diabetic kidney disease (DKD), manifesting excessive proteinuria and/or reduced kidney function (low This article is part of the Topical Collection on Microvascular Complications—Nephropathy * Shivani Ghoshal [email protected] * Barry I. Freedman [email protected] 1
Department of Neurology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
2
Department of Biochemistry and Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
3
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157-1053, USA
estimated glomerular filtration rate [eGFR]) [1]. These phenotypes are distinct processes; some patients present with heavy albuminuria prior to loss of kidney function while others progress to advanced nephropathy with minimal proteinuria. Lowlevel albuminuria, termed micro-albuminuria, is common and levels typically vary over time. The majority of patients with microalbuminuria either stabilizes or go into remission; they do not progress to macro-albuminuria (overt DKD). Microalbuminuria is a harbinger of adverse cardiovascular disease (CVD) events, including myocardial infarction and stroke. It is considered a marker of generalized endothelial dysfunction, not kidney disease per se. The excess mortality in patients with T2D is primarily related to the presence of frank ne
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