Clarifying Molecular Mechanisms and Novel Strategies for Intervention of Uremia and Cognitive Decline.

BACKGROUND

Uremia is now considered to be one of the most relevant causes of dementia, but at that time, it was defined as a sign of the failure of the kidney. The condition of CKD patients is cognitive impairment, which sometimes progresses to dementia; that condition was mentioned very often in cases on dialysis. However, it is still uncertain whether uremia is directly connected with cognitive dysfunction.

SUMMARY: More recent studies indicate that factors associated with uremic toxicity are affected by changes in protein and metabolic waste products in plasma along with inflammatory cytokines. The presence of these toxins, inflammation, oxidation damage, and alteration in vascular properties of the brain could at least affect the quality of neuronal integrity in the affected cerebral system. This review provides an overview of molecular aspects contributing to neuro-cognition in uremia about the brain's vulnerability to exposure to toxins. Emerging treatment strategies include prevention by way of biomarker identification and early intervention in addition to the help of innovative imaging approaches as well as precision medicine strategies. Certainly, regarding the problem of cognitive impairment, one can discuss the creation of new therapeutic approaches, which include the queries of neuroprotective drugs and the improvement of the methods of hemodialysis and renal transplantation.

KEY MESSAGES: This study calls for a multifaceted approach to both the understanding and treatment process of cognitive decline in uremic patients, bridging nephrology with neurology and proposing future directions for research and practice.