ABSTRACT
Kidney failure is one of the leading causes of disability and death and one of the most disabling features of kidney failure and dialysis is encephalopathy. This is probably caused by the accumulation of uremic toxins. Other important causes are related to the underlying disorders that cause kidney failure, particularly hypertension. The clinical manifestations of uremic encephalopathy include mild confusional states to deep coma, often with associated movement disorders, such as asterixis. Most nephrologists consider cognitive impairment to be a major indication for the initiation of renal replacement therapy with dialysis with or without subsequent transplantation. Sleep disorders, including Ekbom's syndrome (restless legs syndrome) are also common in patients with kidney failure. Renal replacement therapies are also associated with particular neurologic complications including acute dialysis encephalopathy and chronic dialysis encephalopathy, formerly known as dialysis dementia. The treatments and prevention of each are discussed.
KEYWORDS
Uremic encephalopathy - uremia - restless legs syndrome - dialysis dementia - dialysis encephalopathy
REFERENCES
-
1
Brouns R, De Deyn P P.
Neurological complications in renal failure: a review.
Clin Neurol Neurosurg.
2004;
107
(1)
1-16
-
2
Burn D J, Bates D.
Neurology and the kidney.
J Neurol Neurosurg Psychiatry.
1998;
65
(6)
810-821
-
3
Smogorzewski M J.
Central nervous dysfunction in uremia.
Am J Kidney Dis.
2001;
38
(4, Suppl 1)
S122-S128
-
4
Vanholder R, Glorieux G, DeSmet R, Lameire N.
New insights in uremia toxins.
Kidney Int Suppl.
2003;
63
6-10
-
5
De Deyn P P, D'Hooge R, Van Bogaert P P, Mareskau B.
Endogenous guanidine compounds as uremic neurotoxins.
Kidney Int.
2001;
59
S77-S83
-
6
De Deyn P P, Vanholder R, D'Hooge R.
Nitric oxide in uremia: effects of several potentially toxic guanidine compounds.
Kidney Int.
2003;
63
S25-S28
-
7
Ohtsuki S, Asaba H, Takanaga H et al..
Role of blood-brain barrier organic anion transporter 3 (OAT3) in the efflux of indoxyl sulfate, a uremic toxin: its involvement in neurotransmitter metabolite clearance from the brain.
J Neurochem.
2002;
83
(1)
57-66
-
8
Fraser C L, Arieff A I.
Nervous system complications in uremia.
Ann Intern Med.
1988;
109
(2)
143-153
-
9
Lockwood A H.
Neurologic complications of renal disease.
Neurol Clin.
1989;
7
(3)
617-627
-
10
Aguilera A, Codoceo R, Bajo M A et al..
Eating behavior disorders in uremia: a question of balance in appetite regulation.
Semin Dial.
2004;
17
(1)
44-52
-
11
Mehta R L, Pascual M T, Soroko S Program to Improve Care in Acute Renal Disease et al.
Spectrum of acute renal failure in the intensive care unit: the PICARD experience.
Kidney Int.
2004;
66
(4)
1613-1621
-
12
Tyler H R.
Neurologic disorders seen in the uremic patient.
Arch Intern Med.
1970;
126
(5)
781-786
-
13
Gipson D S, Wetherington C E, Duquette P J, Hooper S R.
The nervous system and chronic kidney disease in children.
Pediatr Nephrol.
2004;
19
(8)
832-839
-
14
Balzar E, Saletu B, Khoss A, Wagner U.
Quantitative EEG: investigation in children with end stage renal disease before and after haemodialysis.
Clin Electroencephalogr.
1986;
17
(4)
195-202
-
15
Stivelman J C.
Benefits of anaemia treatment on cognitive function.
Nephrol Dial Transplant.
2000;
15
(Suppl 3)
29-35
-
16
Hanly P.
Sleep apnea and daytime sleepiness in end-stage renal disease.
Semin Dial.
2004;
17
(2)
109-114
-
17
Ekbom K A.
Asthenia crurum paraesthetica (irritable legs).
Acta Med Scand.
1944;
118
197-209
-
18
Earley C J.
Clinical practice. Restless legs syndrome.
N Engl J Med.
2003;
348
(21)
2103-2109
-
19
Collado-Seidel V, Winkelmann J, Trenkwalder C.
Aetiology and treatment of restless legs syndrome.
CNS Drugs.
1999;
12
9-20
-
20
Barrière G, Cazalets J R, Bioulac B, Tison F, Ghorayeb I.
The restless legs syndrome.
Prog Neurobiol.
2005;
77
(3)
139-165
-
21
Arieff A I.
Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention.
Kidney Int.
1994;
45
(3)
629-635
-
22
Alfrey A C.
Dialysis encephalopathy.
Kidney Int Suppl.
1986;
18
(S18)
S53-S57
Martin A SamuelsM.D.
Chairman, Department of Neurology, Brigham and Women's Hospital, Professor of Neurology, Harvard Medical School
75 Francis Street, Boston, MA 02115
Email: msamuels@partners.org
