Brain Science

This Medical Procedure Contributes to Dementia

This Medical Procedure Contributes to Dementia about undefined
Your kidneys are fist-sized organs that filter toxins out of your blood and release hormones, red blood cells and Vitamin D into it. Obviously, kidney health is essential to overall health… But what’s interesting is that researchers have recently noticed a connection between the kidneys and the brain. For example, people with chronic kidney disease (CKD) have higher incidence of diabetes, hypertension, elevated homocysteine levels and other factors that increase the risk of developing dementia and Alzheimer’s disease. As if that wasn’t incentive enough to do what you have to do to maintain healthy kidneys, new research reveals alarming risks to people on long-term dialysis and people with end-stage renal disease (ESRD)…

The Harm That Dialysis Does

Dialysis is the process that uses a machine to do what failing kidneys can no longer do: filter waste and toxins from the body. It’s about a three-hour process that allows people with kidney failure to live productive lives, yet it comes at a cost to healthy brain function… Doctors have only recently noticed the connection between cognitive impairment and long-term dialysis. In 2008 it was estimated that up to 70% of dialysis patients aged 55 and older experienced moderate to severe cognitive impairment. Their loss of brain function went largely undiagnosed.1 Researchers have further determined four different kinds of cognitive impairment associated with dialysis:
  • Uremic encephalopathy, caused by uremia, or having too many toxins and waste products in the blood. This condition can actually be helped by short-term dialysis.
  • Dialysis encephalopathy syndrome is caused by aluminum intoxication and was more common before 1980, when aluminum was in the dialysate, the fluid used to remove impurities in the blood. Modern filtering techniques have greatly reduced the amount of aluminum, and therefore reduced the incidence of this particular type of dialysis-related dementia.
  • Dialysis-associated encephalopathy (DAE) is caused by long-term exposure to the trace amounts of aluminum still present in dialysate nowadays. The accumulation of aluminum in the central nervous system contributes to cognitive decline. To reduce the risk of DAE, researchers recommend dietary and medication changes to reduce the amount of phosphate in the blood, which your kidneys have to filter out to stay healthy.
  • Vascular dementia is not restricted to dialysis, but is caused when the brain is starved of oxygen and nutrients, as in a stroke.2
Dialysis increases the risk of developing vascular dementia because, in the process, your blood is slowly pumped from your body into a dialyzer that extracts the waste and then returns the blood to your body. This may interrupt blood flow to the brain. Such an interruption can cause episodes of acute cerebral ischemia that starves neurons and brain tissue of blood. Over time this causes a decline in cognitive functioning that can lead to dementia and Alzheimer’s disease.3 The process of dialysis can also be stressful for the patient, especially those who haven’t received a good explanation of the procedure. The patients may also feel out of control regarding their own health and decisions about their care. Because of this, depression and anxiety are also common among people with end-stage renal disease (ESRD).4 (See Issue #117 and Issue #298 for more information about depression and anxiety as risk factors for dementia.) From everything I’ve heard, a dialysis patient’s overall quality of life is not good, but there may be few or no alternatives available for people who suffer kidney failure.

Kidney Transplants

If possible, a kidney transplant is a good option. Not only does a successful transplant remove the need for dialysis, but it can improve overall health. A study published in the January 2016 issue of BMC Nephrology found that patients who received a kidney transplant, who had previously been on three-times-a-week hemodialysis, showed improvement in memory and fine motor skills.5 Of course, a kidney transplant is an extreme measure and has its own set of risks. A study published in the October 2016 issue of Journal of the American Society of Nephrology found that older ESRD patients with diabetes who received a kidney transplant had an increased risk of developing dementia and Alzheimer’s disease. This was due either to the long-standing kidney disease or to neurotoxic immunosuppressant drugs given to organ recipients to prevent the body’s rejection of the new organ.6

Take These Steps to Keep Your Kidneys Healthy

If you have risk factors for developing kidney disease, or if you have it now, make lifestyle changes to keep your kidneys as healthy as possible. Here’s what the National Kidney Foundation recommends. . .
  • Eat a well-balanced diet of whole, nutritious foods
  • Exercise regularly
  • Avoid NSAIDs like ibuprofen
  • Manage blood sugar/diabetes and blood pressure
  • Maintain a healthy weight
  • Don’t smoke
  • Limit alcohol intake7
Making healthy choices now can have a positive impact on your overall quality of life down the road. While a healthy lifestyle may not be very "sexy," it’s a lot more enjoyable than kidney failure and Alzheimer’s disease.
  1. Cognitive impairment in the aging dialysis and chronic kidney disease populations: An occult burden.
  2. Dementia in patients undergoing long-term dialysis: Aetiology, differential diagnoses, epidemiology and management.
  3. Cognitive impairment in the aging dialysis and chronic kidney disease populations: An occult burden.
  4. Psychiatric issues in renal failure and dialysis.
  5. Cognitive changes associated with switching to frequent nocturnal hemodialysis or renal transplantation.
  6. Dementia and Alzheimer’s disease among older kidney transplant recipients.
  7. National Kidney Foundation.

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