Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Pedro Imenez Silva (1, 2) , Robert Unwin (3) , Ewout Hoorn (4) , Alberto Ortiz (5) , Francesco Trepiccione (6, 7) , Rikke Nielsen (8) , Vesna Pesic (9) , Gaye Hafez (10) , Denis Fouque (11, 12) , Ziad Massy (13, 14) , Chris de Zeeuw (4, 15) , Giovambattista Capasso (6, 7) , Carsten Wagner (1, 2) , Olivier Godefroy (16, 17) , Jean-Marc Chillon (16, 18)

1 UZH - Universität Zürich [Zürich] = University of Zurich
2 NCCR-Chemical Biology - Swiss National Centre for Competence in Research Programme Chemical Biology
3 Royal Free Hospital [London, UK]
4 Erasmus University Rotterdam
5 UAM - Universidad Autónoma de Madrid
6 Biogem S. C. A. R. L.
7 University of the Study of Campania Luigi Vanvitelli
8 Aarhus University [Aarhus]
9 University of Belgrade [Belgrade]
10 Altinbas University [Istanbul, Turkey]
11 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
12 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
13 Hôpital Ambroise Paré [AP-HP]
14 U1018 (Équipe 5) - Épidémiologie et recherches translationnelles sur les maladies rénales et cardiovasculaires (EPREC)
15 NIN - Netherlands Institute for Neuroscience
16 CHU Amiens-Picardie
17 LNFP - Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559
18 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

Metabolic acidosis, defined as a plasma or serum bicarbonate concentration <22 mmol/L, is a frequent consequence of chronic kidney disease (CKD) and occurs in ~10–30% of patients with advanced stages of CKD. Likewise, in patients with a kidney transplant, prevalence rates of metabolic acidosis range from 20% to 50%. CKD has recently been associated with cognitive dysfunction, including mild cognitive impairment with memory and attention deficits, reduced executive functions and morphological damage detectable with imaging. Also, impaired motor functions and loss of muscle strength are often found in patients with advanced CKD, which in part may be attributed to altered central nervous system (CNS) functions. While the exact mechanisms of how CKD may cause cognitive dysfunction and reduced motor functions are still debated, recent data point towards the possibility that acidosis is one modifiable contributor to cognitive dysfunction. This review summarizes recent evidence for an association between acidosis and cognitive dysfunction in patients with CKD and discusses potential mechanisms by which acidosis may impact CNS functions. The review also identifies important open questions to be answered to improve prevention and therapy of cognitive dysfunction in the setting of metabolic acidosis in patients with CKD.

Mots clés: acidosis; chronic kidney disease; cognitive dysfunction; klotho; motor function

Domaines: Urologie et Néphrologie

Pedro Imenez Silva, Robert Unwin, Ewout Hoorn, Alberto Ortiz, Francesco Trepiccione, et al.. Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease. Nephrology Dialysis Transplantation, 2022, 37 (Supplement_2), pp.ii4-ii12. ⟨10.1093/ndt/gfab216⟩. ⟨hal-03557647⟩