Table 1

Supporting evidence for the central role of cerebrovascular disease in cognitive impairment in CKD

Vascular hypothesisNeurodegenerative hypothesis

  • Frequently occurring traditional risk factors, including hypertension, smoking, diabetes mellitus and ageing.

  • Positive correlation between haemodynamic and cognitive impairment from TCD studies.

  • Transient ‘cerebral stunning’ in haemodialysis patients associated with accelerated cognitive decline.

  • High burden of subclinical SVD, including silent lacunar infarcts, WML and CMBs.

  • Typical pattern of cognitive impairment with greater deficits in executive function and speed of information processing.

  • Chronic hypertension, highly prevalent in CKD, is known to lower the pathological threshold at which Alzheimer’s disease features manifest.

  • Chronic cerebral inflammation due to CKD and associated vascular risk factor exposure can increase beta-amyloid production.

  • Higher beta-amyloid levels and impaired clearance in CKD, compounded by SVD and vascular inflammation.

  • CKD, chronic kidney disease; CMB, cerebral microbleed; SVD, small-vessel disease; TCD, transcranial doppler; WML, white matter lesion.