终末期肾病患者认知功能障碍的发生机制与干预策略新进展

New developments in the pathogenesis and intervention strategies of cognitive impairment in patients with end-stage renal disease

终末期肾病(end-stage renal disease,ESRD)即各种慢性肾脏疾病的终末阶段,发病率与病死率均较高。认知功能障碍(cognitive impairment,CI)在ESRD患者中广泛存在,是决定ESRD患者远期预后和生活质量的重要因素,但ESRD患者发生CI的机制及其干预策略仍不明确。本文基于尿毒症毒素的中心作用探讨了其通过产生心血管及神经毒性来诱导内皮功能障碍、骨代谢失衡及遥感与信号传导系统紊乱的途径促进CI的发生与进展,并进一步阐述了包括应用动态视网膜血管分析、优化血液净化方案、药物管理和营养干预等策略,旨在改善ESRD患者的认知功能及预后。

End-stage renal disease(ESRD)due to various chronic kidney diseases has a high mor-bidity and mortality rate.Cognitive impairment(CI)affects negatively long-term prognosis and quality-of-life.However,the mechanisms and intervention strategies for CI have remained elusive.This review fo-cused upon the central role of uremic toxins in inducing endothelial dysfunction,an imbalance of bone metabolism and remote sensing and signaling through cardiovascular and neurotoxic effects.Furthermore,it elaborated upon dynamic retinal vascular analysis,optimal blood purification protocol,pharmacological management and nutritional interventions,aiming at improving cognitive function and prognosis of ESRD patients.