Characterisation of brain and cognitive abnormalities across various stages of chronic kidney disease

Abstract

Chronic kidney disease (CKD) is common and CKD is a risk factor for stroke and for cognitive impairment (CI). Up until recently the cerebro-renal axis has largely been overlooked in the field of renal research. This thesis describes the importance of previous stroke in a non-dialysis CKD (ND-CKD) population in relation non-fatal cardiovascular events, progression to end stage renal disease (ESRD) and death. Propensity matching methodology was then utilised to understand if patients with a stroke and ND-CKD are more inflamed than patients with similar cardiovascular comorbidities but without a previous stroke event. Whilst higher levels of inflammatory biomarkers (C-reactive protein, Interleukin-6, Von Willebrand Factor) were independently associated with mortality, there was no significant indication that patients with stroke have a higher level of inflammation than patients without a stroke. Assessment of cognition is recommended as part of standard care in advanced CKD but this is not routinely performed in clinical practice. This thesis explores the prevalence and domains of CI in different CKD patient populations - ND-CKD, ESRD and in haemodialysis patients willing to undergo an intradialytic exercise-based intervention. The graded interrelationship between increased CI incidence and severity with worse renal function denotes that patients about to commence dialysis are the most at-risk group. However, this population is the most poorly studied. I performed a feasibility study of an in-depth assessment of cognition specifically in this transitional population.

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Philip Kalra (Supervisor), Aghogho Odudu (Supervisor) & Daniela Montaldi (Supervisor)