Short Communication

This article highlight a very important aspect of neurologic consequences associated with End-stage renal disease (ESRD) and would like to add our reviews regarding ESRD and how its early and proper management can affect the overall mortality and morbidity associated with ESRD as well as how early management will lead to improved cognitive status in these patients. The very finding of decreased cortical thickness, as well as declining cognitive function in patients with ESRD, should prompt us to think about managing kidney problems as soon as they start since they can lead to impaired cognitive status and debilitating mental conditions overtime which ultimately leads to death [1, 2]. It is therefore very important for us to start evaluating and detecting brain abnormalities in patients with chronic kidney disease (CKD) who have no apparent neurological symptoms which will help us improve the prognosis of patients with ESRD and may lead to a significant reduction in death rates associated with it. [1, 2].

Uremia causes the accumulation of certain toxic substances like urea, creatinine, guanidine, guanidinosuccinic acid, and methylguanidine in the brain and cerebrospinal fluid (CSF) and this accumulation of toxins everywhere is the core issue associated with CKD and ESRD [3]. These toxins are present in their highest concentrations in the thalamus, mamillary bodies, and cerebral cortex among the different areas of the brain, and these areas are highly associated with cognitive function and any impairment involving them profoundly affects the neurological status of the patient [3].

What is crucial for us is to start taking into consideration the neurological consequences as soon as the patient is diagnosed with CKD or ESRD even if he/she does not have any complaints about the nervous system. More researches are required to evaluate patients with CKD/ESRD who are undergoing regular dialysis to assess if commencing early dialysis in the course of CKD is associated with any reductions in neurological derangements and improvement of overall survival and prognosis. We would also like to add the importance of ameliorating anemia associated with renal failure and improving the metabolic derangements which can help to prevent the accumulation of toxic substances inside the central nervous system and thus enhancing brain function as well as decrease the risk of developing depression and improving quality of life [4-6]. It is thus emphasized that managing CKD/ESRD by reducing the levels of metabolic toxins as well as optimizing the levels of hemoglobin, calcium, magnesium and other electrolytes can significantly alter the course of the disease and overall prognosis.

Disclosure

The authors report no conflicts of interest in this work.

References

1. Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int 79 (2011): 14-22.
2. Raphael KL, Wei G, Greene T, et al. Cognitive function and the risk of death in chronic kidney disease. Am J Nephrol 35 (2012): 49-57.
3. De Deyn PP, Vanholder R, Eloot S, et al. Guanidino compounds as uremic (neuro) toxins. Semin Dial 22 (2009): 340-345.
4. Kuwabara Y, Sasaki M, Hirakata H, et al. Cerebral blood flow and vasodilatory capacity  in  anemia  secondary  to  chronic  renal  Kidney Int 61 (2002): 564-569.
5. Kalender B, Ozdemir AC, Koroglu G. Association of depression with markers of nutrition and inflammation in chronic kidney disease and end-stage renal disease. Nephron Clin Pract 102 (2006): c115-c121.
6. Teles F, Azevedo VF, Miranda CT, et al. Depression in hemodialysis patients: the role of dialysis shift. Clinics 69 (2014): 198-202.