Chronic Kidney Disease and Neurocognition

2019 ◽  
pp. 136-147
Author(s):  
David A. Drew ◽  
Daniel E. Weiner
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Neurocognitive Impairment ◽  
Cognitive Changes ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Patients with kidney disease are at high risk for developing neurocognitive impairment. Declining kidney function and proteinuria are both strongly associated with a greater prevalence and severity of impairment. Cerebrovascular disease is thought to be the predominant pathophysiologic process underlying the association between kidney disease and neurocognitive impairment, although retention of uremic metabolites may also contribute. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to reduce proteinuria in patients with chronic kidney disease may limit cognitive decline, although whether this is a result of slower kidney function decline is uncertain. Dialysis treatments mitigate cognitive changes specifically related to uremia but do not improve underlying neurocognitive impairment if present. Limited data indicate that kidney transplantation may result in improved cognitive function in many transplant recipients, suggesting a prominent role for a well-functioning kidney in neurocognitive function. Reflecting the underlying pathology, neurocognitive tests that include assessment of executive function are recommended for patients with kidney disease.

Intraoperative Hyperkalemia

2018 ◽  
pp. 269-274
Author(s):  
M. Angele Theard ◽  
Alexandra Bastien
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Close Monitoring ◽  
Converting Enzyme Inhibitors ◽  
Renin Inhibitors ◽  
Increased Risk ◽  
Receptor Blockers

Patients with hypertension, diabetes, and heart disease are at risk for chronic kidney disease and therefore require close monitoring of potassium (K+) levels in order to avoid some of the more concerning consequences of hyperkalemia. Medical therapy in these patients, which often includes angiotensin converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor antagonists, while helpful in managing some of the aforementioned comorbidities and ameliorating chronic kidney disease in these patients, places them at increased risk for unwanted K+ elevations. Symptoms of hyperkalemia maybe nonspecific (fatigue, weakness, and gastrointestinal upset), requiring attention therefore to preoperative laboratory analysis to avert the potentially lethal intraoperative consequences of hyperkalemia like asystole and ventricular fibrillation. Emergency surgery in these patients after trauma complicated by crush injury is particularly challenging requiring that the anesthesiologist be well-versed in recognizing the signs of and managing intraoperative hyperkalemia.

scholarly journals Eat Your Broccoli: Oxidative Stress, NRF2, and Sulforaphane in Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 266
Author(s):  
Scott E. Liebman ◽  
Thu H. Le
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Therapeutic Potential ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
End Stage

The mainstay of therapy for chronic kidney disease is control of blood pressure and proteinuria through the use of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) that were introduced more than 20 years ago. Yet, many chronic kidney disease (CKD) patients still progress to end-stage kidney disease—the ultimate in failed prevention. While increased oxidative stress is a major molecular underpinning of CKD progression, no treatment modality specifically targeting oxidative stress has been established clinically. Here, we review the influence of oxidative stress in CKD, and discuss regarding the role of the Nrf2 pathway in kidney disease from studies using genetic and pharmacologic approaches in animal models and clinical trials. We will then focus on the promising therapeutic potential of sulforaphane, an isothiocyanate derived from cruciferous vegetables that has garnered significant attention over the past decade for its potent Nrf2-activating effect, and implications for precision medicine.

scholarly journals The impact of ramipril on kidney function parameters in the chronic kidney disease patient with hypertension

2020 ◽  
Vol 11 (4) ◽  
pp. 6932-6937
Author(s):  
Mohammed Salim KT ◽  
Saravanakumar RT ◽  
Dilip C ◽  
Amrutha KP
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Enzyme Inhibitors ◽  
Disease Patient ◽  
Cost Effective ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Cost Effective Technique ◽  
The Impact

The administration of angiotensin converting enzyme inhibitors had gain popularity owing to their efficacy and safety in chronic kidney disease (CKD) patients. However, it is certainly necessary to look into the impact of the ramipril in kidney impaired individuals. We had enrolled 190 CKD with hypertensive patients based on the exclusion and inclusion criteria. The elder patients constituted to have a major share in the CKD population on ramipril therapy. From the study, it was found that the high costly brand was chosen the most and least cost was preferred only for 2 patients. The glomerular filtration rate (GFR) and serum creatinine, the major determinants of kidney function, had a small relationship with the dose of ramipril. However, the antihypertensive drug showed to have a favorable impact on patients overall treatment outcome. It is vital to evaluate the amount of protein in urine in case of a CKD patient. The easiest and cost effective technique, the dipstick urine protein test was done. The test value was found to be 1+ (30mg/dl) for majority of the patients and only 2 patients were observed with more than 1000 mg/dl. The ability of ramipril to reduce the progression of CKD can be attributed to the pooling of the data in +1 (30mg/dl) range.

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