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. 2026 Feb 13;105(7):e47621. doi: 10.1097/MD.0000000000047621

Bibliometric analysis of cognitive impairment secondary to chronic kidney disease

Yanran Chen a,b, Ruiting Zhu a,b, Xinyi Zhu a, Qiange Zhu a, Zhaoyao Luo a, Junya Mu a, Ming Zhang a, Shaohui Ma a,*
PMCID: PMC12908808  PMID: 41686608

Abstract

Background:

Cognitive impairment (CI) is a common complication in chronic kidney disease (CKD) patients, affecting 10% to 50% of individuals depending on disease stage. Despite its clinical significance, the molecular mechanisms remain unclear, and effective interventions are lacking. This bibliometric analysis aimed to comprehensively map the research landscape of CI secondary to CKD from 1995 to 2024, identifying trends, key contributors, and evolving foci.

Methods:

A total of 1783 English original articles and reviews were retrieved from the Web of Science Core Collection. Bibliometric analysis was performed using R-bibliometrix (v4.4.2), CiteSpace (v6.3.1), and Excel 2024. Metrics included annual publications, country/affiliation contributions, journal impact (H-index, Bradford Law), citation analysis (local/global citations), author influence (H-index), keyword co-occurrence, burst detection, and thematic evolution.

Results:

Publications surged after 2016, with the United States leading output (nearly 500 articles) and collaborations. The University of California System was the top affiliation (n = 243). Core journals were Nephrology Dialysis Transplantation, American Journal of Kidney Diseases, and Clinical Journal of the American Society of Nephrology. Yaffe K was the most influential author (H-index = 19). Key articles by Kurella M and Murray AM were highly cited. Keyword analysis revealed shifting themes: early research focused on prevalence and clinical associations, while current hotspots emphasized molecular mechanisms (α-Klotho, NLRP3 inflammasome) and comorbidities (fatty liver disease).

Conclusions:

Research on CKD-associated CI has expanded significantly, with a paradigm shift toward mechanistic exploration. The USA dominates scholarly output, and interdisciplinary collaboration is critical. Emerging themes highlight the roles of inflammation, metabolic dysregulation, and organ crosstalk. These insights inform future research directions, clinical screening strategies, and therapeutic targeting for CI in CKD.

Keywords: bibliometric analysis, chronic kidney disease, citespace, cognitive impairment, R-bibliometrix

1. Introduction

Chronic kidney disease (CKD) is defined as structural or functional renal abnormalities persisting for at least 3 months and is typically characterized by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or markers of kidney injury such as albuminuria.[1] As a progressive disorder affecting more than 10% of the global population (approximately 840 million individuals),[2] CKD has emerged as a major public health crisis because of its high prevalence and substantial socioeconomic burden.

Cognitive impairment (CI), defined as a decline in one or more cognitive domains, including memory, attention, and executive function,[3] manifests in 10% to 50% of CKD patients depending on the disease stage and assessment methodologies.[4–8] CI not only reduces medication adherence[9] but also elevates dementia conversion risk,[10–13] thereby adversely affecting patients’ quality of life and clinical outcomes. These findings underscore the clinical and theoretical significance of investigating CKD-associated CI.

Compared with healthy individuals, patients with CKD face over twice the risk of developing CI.[8,14] CKD induces cerebral injury through inflammatory–oxidative stress cascades, uremic toxin accumulation, and hemodynamic instability.[3,15] However, the molecular basis of network-level interactions among these pathways remains unclear, resulting in clinical interventions that do not integrate pathogenic networks.[16] Additionally, no consensus-based screening algorithms exist,[3] and current therapies fail to halt CI progression.[16]

Given the current research status and gaps, bibliometrics, as a scientific research method, can help systematically organize research progress and hot topics. By analyzing key factors such as publication patterns, influential authors, and frequently used keywords, bibliometrics can identify research priorities and guide future investigations.[17] This study employs bibliometric methods to explore the research landscape of CI secondary to CKD, aiming to provide insights that can inform clinical practice and future research directions.

2. Methods

2.1. Data collection and search strategy

We utilized MeSH word retrieval from the PubMed database to search for free words related to CKD and CI, and added an additional related term, renal cognitive dysfunction. Owing to its authoritative and open nature, the Web of Science Core Collection (WOSCC) was chosen as the data source. Its wide recognition for reliability and data updates has made it an important tool for academic research.[18] We searched all the studies on CI secondary to CKD from January 1, 1995, to December 31, 2024. The search terms used were ((((((((TS = (Renal Insufficiency, Chronic)) OR TS = (Chronic Renal Insufficiencies)) OR TS = (Chronic Kidney Insufficiency)) OR TS = (Chronic Kidney Insufficiencies)) OR TS = (Chronic Renal Insufficiency)) OR TS = (CKD*)) OR TS = (Disease*, Chronic Kidney)) OR TS = (Chronic Renal Disease*)) AND (((((((((TS = (Cognitive Dysfunction*)) OR TS = (Cognitive Disorder*)) OR TS = (CI*)) OR TS = (Mild CI*)) OR TS = (CI*, Mild)) OR TS = (Cognitive Decline*)) OR TS = (Mental Deterioration*)) OR TS = (MCI*)) OR TS = (Renal cognitive dysfunction)). We retrieved 1983 articles and exported the article information to a plain text file. In the screening process, only the original research and review literature published in English were retained. After 200 irrelevant documents were eliminated, 1783 valid documents were ultimately obtained. The specific retrieval and screening process is shown in Figure 1. Notably, this study utilized publicly available data from the WOSCC. As such, ethical committee approval and informed consent were not required.

Figure 1.

Figure 1.

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Flow diagram of the selection process for the included studies.

2.2. Bibliometric analysis

In this study, we used CiteSpace (6.3.1), Excel 2024, and the R (4.4.2) package “bibliometrix” to conduct bibliometric analysis. CiteSpace is mainly used for keyword analysis and presents keyword information in another form. Excel 2024 is used to sort out the data after the R package “bibliometrix” and CiteSpace analysis, and makes line charts and tables to visually show the changing trend of data with variables and summarize information. The R package “bibliometrix” is used for visual analysis of the number of published articles, research countries/regions, affiliations, journals, cited articles, references, authors, theme trends, and theme evolution.

In this paper, a variety of indicators and methods are used to analyze the relevant literature. Among them, the H-index[19] is a comprehensive quantitative index used to measure the quantity and quality of academic output of researchers (or scientific research affiliations, academic journals, etc) and can comprehensively reflect the influence of researchers in their (or scientific research affiliations, academic journals, etc) academic fields. Bradford law[20] identifies the core journals of Zone 1 by literature sources, and its highly cited literature has important reference value for the research topic. Local citation (LC) refers to the number of times an article has been cited in a specific local environment. It reflects the influence and recognition gained by an article within a certain local scope. Global citation (GC) represents the total number of citations accumulated by an article around the world, indicating its wider international influence and significance in global research. The ratio of LC/GC is a relative index used to measure the balance between LCs and GCs in a paper. Normalized LC (Normalized LC) uses the LC data after normalization to perform more reasonable and comparable analyses and evaluations in different research objects or time ranges.

3. Results

3.1. Annual publication analysis

As shown in Figure 2, research on CI secondary to CKD can be roughly divided into 3 time periods. From 1995 to 2005, only a few articles were published each year, fewer than 10. From 2006 to 2015, the number of published articles subsequently increased, showing a gradual upward trend, except for a slight decrease in 2012. From 2016 to 2024, the number of papers per year exceeded 90, which showed a trend of sustained and rapid growth, highlighting the increasingly prominent and extensive academic concern in this field.

Figure 2.

Figure 2.

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Trend analysis of the number of CIs secondary to CKD publications from 1995 to 2024. CI = cognitive impairment, CKD = chronic kidney disease.

3.2. Analysis of countries/regions

Figure 3A shows that the United States (USA) has conducted the most research in the field of CI secondary to CKD and has also engaged in extensive cooperation with other countries. Specifically, the USA has the highest frequency of cooperation, especially with the United Kingdom (40 cases) and China (33 cases). Other noteworthy partners include Italy and Canada, with 26 and 24 cooperation projects, respectively. Figure 3B shows the research output of various countries in the field of CI secondary to CKD and the extent of international cooperation. The USA has published nearly 500 articles, with both its independent research and international collaborative research outcomes being outstanding. China has followed closely and published nearly 300 papers.

Figure 3.

Figure 3.

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(A) Countries’ collaboration world map in the fields of CI secondary to CKD. (B) Top 10 countries ranked according to the publications of communication authors. CI = cognitive impairment, CKD = chronic kidney disease, MCP = multiple countries’ publications, SCP = single-country publications.

3.3. Analysis of affiliations

Figure 4 illustrates the top 10 affiliations that have published the largest number of articles. The 3 affiliations with the highest article output are the University of California System (n = 243), the University of California San Francisco (n = 128), and the US Department of Veterans Affairs (n = 125). These affiliations all belong to the USA, which shows that the USA has a high level of participation in research on CI secondary to CKD.

Figure 4.

Figure 4.

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The top 10 affiliations by the number of publications.

3.4. Analysis of journals

We used the H-index and Bradford law to analyze the periodical ranking, supplemented by the data of the impact factor (IF). The IF[21] reflects the average number of citations for articles published in a journal’s first 2 years, serving as a key indicator of its relevance and influence within the field. Table 1 shows that the American Journal of Kidney Diseases (IF = 9.4) has the highest degree of academic influence, with an H-index of 31. Although its number of publications is not the highest, its total citation count (TC) is 3381. The following closely followed the Clinical Journal of the American Society of Nephrology (IF = 8.5) and Nephrology Dialysis Transplantation (IF = 4.8). Bradford law identifies the core journals in this field, with Nephrology Dialysis Transplantation (IF = 4.8) publishing the most articles, followed by the American Journal of Kidney Diseases (IF = 9.4) and the Clinical Journal of the American Society of Nephrology (IF = 8.5). These 3 journals consistently rank among the top 3 in terms of both sorting methods. These findings demonstrate that these 3 journals have a significant influence on and recognition within the research field concerning CI secondary to CKD.

Table 1.

The top 10 journals ranked by H-index and Bradford law.

Rank Journal H-index Publications TC IF Rank Journal Publications Zone IF
1 American Journal of Kidney Diseases 31 40 3381 9.4 1 Nephrology Dialysis Transplantation 44 Zone 1 4.8
2 Clinical Journal of the American Society of Nephrology 26 38 2506 8.5 2 American Journal of Kidney Diseases 40 Zone 1 9.4
3 Nephrology Dialysis Transplantation 22 44 1602 4.8 3 Clinical Journal of the American Society of Nephrology 38 Zone 1 8.5
4 Kidney International 19 23 1555 14.8 4 PLOS One 37 Zone 1 2.9
5 Journal of the American Geriatrics Society 17 25 1324 4.3 5 BMC Nephrology 35 Zone 1 2.2
6 PLOS One 15 37 794 2.9 6 Journal of the American Geriatrics Society 25 Zone 1 4.3
7 BMC Nephrology 14 35 524 2.2 7 Kidney International 23 Zone 1 14.8
8 American Journal of Nephrology 11 15 620 4.3 8 Scientific Reports 23 Zone 1 3.8
9 Journal of the American Society of Nephrology 11 13 1766 10.3 9 BMJ Open 20 Zone 1 2.4
10 BMJ Open 10 20 313 2.4 10 Journal of Clinical Medicine 20 Zone 1 3.0
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The table on the left is arranged according to the H-index, and the table on the right is arranged according to Braford law.

IF = impact factor, TC = total citations.

3.5. Analysis of article citations

To some extent, a paper’s quality and disciplinary impact are reflected in its citation count.[22] Table 2 lists the 10 most cited articles (sorted by descending LC). The article with the highest number of LCs was “CKD and CI in elderly individuals: the health, aging, and body composition study.”[23] The next 2 articles were “CI in CKD”[24] and “Kidney function and CI in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.”[25] Additionally, the article “CKD, cognitive decline, and incident dementia: the 3C Study” demonstrated the highest LC/TC ratio.[26]

Table 2.

The top 10 cited articles ranked.

Rank Document DOI LC GC LC/GC ratio (%) Normalized LC
1 Kurella M, 2005, J Am Soc Nephrol 10.1681/ASN.2005010005 215 366 58.74 4.82
2 Kurella M, 2004, J Am Geriatr Soc 10.1111/j.1532-5415.2004.52508.x 207 375 55.20 6.41
3 Tamura MK, 2008, Am J Kidney Dis 10.1053/j.ajkd.2008.05.004 168 294 57.14 7.62
4 Yaffe K, 2010, J Am Geriatr Soc 10.1111/j.1532-5415.2009.02670.x 152 238 63.87 10.82
5 Etgen T, 2012, Am J Nephrol 10.1159/000338135 140 247 56.68 18.48
6 Murray AM, 2008, Adv Chronic Kidney D 10.1053/j.ackd.2008.01.010 127 303 41.91 5.76
7 Helmer C, 2011, Neurology 10.1212/WNL.0b013e31823b4765 102 157 64.97 7.43
8 Sehgal AR, 1997, Am J Kidney Dis 10.1016/S0272-6386(97)90563-1 100 208 48.08 2.91
9 Tamura MK, 2011, Kidney Int 10.1038/ki.2010.336 97 231 41.99 7.07
10 Drew DA, 2019, Am J Kidney Dis 10.1053/j.ajkd.2019.05.017 97 240 40.42 20.52
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GC = global citations, LC = local citations.

3.6. Analysis of references

Table 3 lists the 10 most cited references. The most cited reference was “CI in hemodialysis patients is common.”[7] The subsequent 2 references were “CKD and CI in elderly individuals: the health, aging, and body composition study”[23] and “CI in CKD.”[24] Notably, among the most cited references, 6 are original articles,[6,7,23,24,27,28] and 4 are reviews.[25,29–31]

Table 3.

The top 10 cited references ranked by citations.

Rank Cited references DOI Citations
1 Murray AM, 2006, Neurology 10.1212/01.WNL.0000225182.15532.40 252
2 Kurella M, 2005, J Am Soc Nephrol 10.1681/ASN.2005010005 215
3 Kurella M, 2004, J Am Geriatr Soc 10.1111/J.1532-5415.2004.52508.X 207
4 Bugnicourt JM, 2013, J Am Soc Nephrol 10.1681/ASN.2012050536 202
5 Folstein MF, 1975, J Psychiat Res 10.1016/0022-3956(75)90026-6 175
6 Tamura MK, 2008, Am J Kidney Dis 10.1053/J.AJKD.2008.05.004 168
7 Yaffe K, 2010, J Am Geriatr Soc 10.1111/J.1532-5415.2009.02670.X 152
8 Seliger SL, 2004, J Am Soc Nephrol 10.1097/01.ASN.0000131529.60019.FA 141
9 Etgen T, 2012, Am J Nephrol 10.1159/000338135 140
10 Murray AM, 2008, Adv Chronic Kidney D 10.1053/J.ACKD.2008.01.010 127
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3.7. Analysis of authors

In the author section, our analysis revealed differences between academic impact indicators and the number of publications (Table 4). The highest H-index is held by Yaffe K, who also has the highest TC. TAMURA MK has an H-index of 18 and a TC of 1777, although he has published more than Yaffe K. Despite FURTH SL’s lower H-index and number of publications compared with HOOPER SR and MASSY ZA, his TC is 968, which is significantly greater than that of HOOPER SR and MASSY ZA. Notably, 4 of them are from the USA, and one is from France.

Table 4.

The top 5 authors ranked by H-index.

Rank Author H-index TC Publications Country
1 Yaffe K 19 2742 24 USA
2 Tamura MK 18 1777 26 USA
3 Hooper SR 13 611 22 USA
4 Massy ZA 13 572 20 France
5 Furth SL 12 968 18 USA
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TC = total citations.

3.8. Analysis of keywords

Keywords identified core research themes and supported focused literature discovery.[22] CiteSpace[32] was utilized for keyword co-occurrence analysis (Fig. 5), where the node size represents the keyword frequency. Larger nodes indicate higher frequency, whereas nodes with high-centrality (purple rings) highlight keywords that bridge distinct research clusters. These high-centrality keywords act as thematic bridges, interconnecting subfields within CI secondary to CKD. Table 5 summarizes the top 10 keywords by frequency and centrality. The 3 most frequent keywords were CKD, CI, and dementia. Notably, risk exhibited the highest centrality, followed by hemodialysis and dementia.

Figure 5.

Figure 5.

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Co-occurring keyword map. The nodes in the map represent keywords. The lines between the nodes represent co-occurrence relationships. The purple ring represents centrality.

Table 5.

Top 10 keywords in terms of frequency of occurrence and centrality.

Rank Keywords Counts Rank Keywords Centrality
1 Chronic kidney disease 616 1 Risk 0.27
2 Cognitive impairment 329 2 Hemodialysis 0.17
3 Dementia 294 3 Dementia 0.13
4 Impairment 277 4 Disease 0.13
5 Risk 255 5 Dialysis 0.11
6 Prevalence 212 6 Cognitive impairment 0.10
7 Risk factors 193 7 Older adults 0.10
8 Older adults 188 8 Chronic kidney disease 0.09
9 Quality of life 173 9 Association 0.08
10 Mortality 169 10 Age related changes 0.08
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Burst keywords refer to words whose frequency of use suddenly increases greatly in a certain period. They can mirror the shift in research hotspots and serve as sensitive indicators of scientific research trends.[22] Figure 6 shows the top 20 keywords with the strongest bursts from 1995 to 2024. The red line denotes the time frame of keyword outbreaks, whereas the blue line represents the time interval when keywords appear. The keywords that were used until 2024 were outcome, hemodialysis, CKD, blood pressure, oxidative stress, dysfunction, impact, and cognitive decline. This suggests that research on these 8 aspects has attracted more attention and that the research trend is intense.

Figure 6.

Figure 6.

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Top 20 keywords with the strongest citation bursts. The blue line indicates the period when keywords appear, and the red line indicates the time period when keywords break out, indicating the beginning year, the ending year, and the duration of the burst.

3.9. Analysis of trend topics

Analyzing the changes in theme trends can help detect research hotspots and development trends in the field.[33] As depicted in Figure 7, a total of 46 hot topics were identified. The themes with high frequency were CKD, CI, dementia, impairment, and risk. Early topics included event-related potentials and recombinant human erythropoietin, but these gradually decreased over time. From 2016 to 2020, several core themes emerged, including dementia, risk, and dysfunction. This evolution indicates a shift in research paradigms from descriptive phenomena to systematic risk assessment and exploration of pathological mechanisms. Current research focuses primarily on fatty liver disease, alpha-klotho, and the NLRP3 inflammasome.

Figure 7.

Figure 7.

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Trend topics of CI secondary to CKD research from 2005--2024. The circle size symbolizes the frequency of the topic, and the blue line indicates the time when the topic frequently emerges. CI = cognitive impairment, CKD = chronic kidney disease.

4. Discussion

In this study, we used bibliometric tools to analyze research hotspots and develop trends of published research in the area of CI secondary to CKD among articles published in the WOSCC. Judging from the final 1783 English original articles and reviews, there was a noticeable decline in the number of articles published in 2012 and 2023, but an overall increase, particularly since 2012. This trend may be due to the increasing incidence and mortality rates of CKD, which have garnered significant attention from researchers.[34] Moreover, the development of neuroimaging techniques, such as functional magnetic resonance imaging[35] and innovative cognitive assessment tools,[36] has promoted research on CI secondary to CKD since the early 2010s.

In the analysis of relevant countries/regions, the number of articles published by the USA far exceeds that published by other countries, which may be related to its significant role in the global burden of CKD. Studies have shown that in 2021, the United States ranked third in terms of the absolute incidence and mortality of CKD.[34] Moreover, a systematic review and meta-analysis of 25,289 CKD patients revealed a 37% prevalence of CI among CKD patients in the USA.[37] Notably, the US government and related institutions invest heavily in medical research, providing ample financial support for such studies.[38] Finally, the country boasts a robust foundation in scientific research, as evidenced by the fact that 7 of the top 10 research institutions are based in the USA.

We subsequently analyzed the relevant journals. Among the top 10 ranked journals, only Kidney International and the Journal of the American Society of Nephrology had IFs >10. Both are leading nephrology journals. The former is renowned globally and publishes top-notch research on kidney-related diseases via a strict peer-review process. The latter bridges basic science and clinical application, focusing on diverse kidney health aspects. This implies that researchers should increase research quality, carry out innovative studies, and strengthen research design to increase the likelihood of publishing in high-impact journals.

We then analyzed the citation frequency of the articles, observing a notable LC/GC ratio of 40% to 60% among the top 10 most cited studies. This suggests that the literature has a significant influence within both local academic circles and the global academic community, with a relatively balanced impact across these spheres. Among the top 10 most cited articles, 5 were clinical studies that consistently indicated a significant association between CKD and CI, with the degree of renal function damage showing a dose–dependent relationship with the risk of cognitive decline. Both nondialysis CKD patients and hemodialysis patients experience impaired cognitive function across multiple domains, such as executive function and memory, with vascular mechanisms possibly playing a key role.[5,6,23,24,26] In addition, 5 review articles ranked among the most cited works, underscoring the field’s focus on elucidating pathological mechanisms and optimizing clinical management rather than solely on clinical outcomes.[3,25,30,31,39] Among them, the original research by Kurella M et al[23] has been cited the most. This study confirmed the association between kidney function decline and accelerated cognitive decline, providing crucial evidence for subsequent mechanistic exploration, clinical research, and public health strategies, and highlighting the importance of nephrology and neurology collaboration in managing chronic diseases in elderly individuals.[23] The most frequently cited reference in the literature is the study by Murray AM et al,[7] which focuses on hemodialysis patients. This study aligns with the research of Kurella M et al[23] conducted in community populations, confirming the association between CKD and CI. Additionally, a previous study revealed that the dialysis dose is related to cognitive damage, providing a direction for exploring the mechanisms of dialysis-related brain injury.[7]

The author with the highest H-index in this field was Yaffe K from the University of California San Francisco Weill Institute for Neuroscience. Yaffe K has been devoted to research in neurology, especially research on different diseases related to CI.[6,40–43] Furthermore, we also found that Yaffe K’s publications on CKD and CI are among the best. For example, in 2010, he published CKD and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study[6] in the Journal of the American Geriatrics Society, ranking 4th in the analysis of citation quantity. This article[6] mainly discusses the relationship between CKD and the cognitive function of elderly individuals, which is highly important for supporting existing research, clarifying the relationship between them, and guiding follow-up mechanism research. Dr Yaffe K is widely recognized as a leading authority in this field.

Keyword burst analysis reveals the dynamic focal points of research. Among the keywords that continue to burst until 2024, we focus on 4 core terms with clear pathological or clinical implications. First, hemodialysis has been continuously bursting from 2020 to 2024, with a burst intensity of 5.87. Hemodialysis is a significant risk factor for secondary CI in CKD patients, with higher risks than does peritoneal dialysis.[44] Next, blood pressure is a keyword with a burst intensity of 8.2, which began to burst in 2021. Studies indicate that hypertension is a key risk factor for secondary CI in CKD patients.[45] Notably, its management strategies have dual effects: aggressive blood pressure reduction can slow cerebral vascular damage but may also lead to accelerated whole-brain volume shrinkage due to insufficient brain perfusion.[46] Additionally, oxidative stress has a high burst intensity of 9.64, starting to burst in 2022. Evidence suggests that it promotes cerebral vascular endothelial injury and blood–brain barrier disruption through uremic toxin mediation, independently driving cognitive decline beyond traditional risk factors.[3] Finally, cognitive decline began to burst in 2022, with a burst intensity of 5.26. CKD patients exhibit cognitive decline across multiple domains, including executive function, memory, and attention, which is directly linked to adverse clinical outcomes.[3,16,26,47] Furthermore, dialysis treatment results in limited improvement in chronic cognitive decline, while kidney transplantation partially reverses executive function deficits, but overall, CIs persist.[3,16]

Trend topics demonstrate the dynamic evolution of research hotspots in the field of CI secondary to CKD. Early research focused primarily on confirming the phenomenon of cognitive dysfunction and exploring simple clinical interventions, such as event-related potential evaluation and the clinical application of erythropoietin.[24,48] Subsequent research phases gradually shifted toward systematic risk assessment and clinical outcome analysis.[3,44,47,49,50] The current research focus has focused on 3 core themes: fatty liver disease, α-Klotho, and the NLRP3 inflammasome, a trend highly consistent with reported research advancements.

Studies indicate that fatty liver disease can induce systemic inflammation and oxidative stress, which disrupt blood–brain barrier integrity and activate neuroinflammatory pathways, thereby indirectly exacerbating cognitive decline in CKD patients.[51,52] Furthermore, the severity of hepatic fibrosis is directly associated with executive dysfunction,[53] suggesting that liver-derived toxins may inflict direct damage to the central nervous system. When fatty liver disease coexists with CKD, concomitant hepatic and renal dysfunction synergistically amplifies cognitive risk, as systemic inflammation and uremic toxin accumulation jointly disrupt neurovascular unit function.[52,54,55] Experimental evidence notably confirms that liver interventions can ameliorate renal injury.[54] During CKD progression, renal α-Klotho protein expression is significantly downregulated. Its deficiency indirectly promotes cerebrovascular damage and CI by exacerbating oxidative stress, systemic inflammation, and calcium–phosphate metabolism dysregulation.[56] Clinical studies have confirmed a positive correlation between serum α-Klotho levels and cerebrospinal fluid concentrations, with both independently predicting cognitive function.[57] In elderly CKD patients with proteinuria, moderately elevated serum Klotho concentrations significantly improve cognitive test performance.[58] The neuroprotective effects of α-Klotho may involve enhancing synaptic plasticity and inhibiting neuronal apoptosis,[59] making targeted upregulation of its expression an emerging strategy for delaying CI secondary to CKD. Concurrently, metabolic disturbances in the CKD state persistently activate the NLRP3 inflammasome, releasing proinflammatory cytokines such as IL-1β and IL-18.[60,61] This systemic inflammatory state affects the central nervous system, ultimately causing neuronal damage and cognitive decline.[62] Therefore, targeted inhibition of the NLRP3 inflammasome pathway is regarded as a significant potential strategy for intervention in CI secondary to CKD.

In this study, the literature in the WOSCC database was retrieved, and the research status of CI secondary to CKD from 1995 to 2024 was analyzed. However, our analysis is limited. First, only English documents were retrieved, which may have led to the omission of some studies and selection bias. In the future, authors should expand their search scope to other databases and languages for a more comprehensive and detailed analysis. Second, we only analyzed the information of countries/regions, affiliations, journals, citations, authors, and keywords from the perspective of bibliometrics and did not analyze the specific content of the research. In the future, we can perform systematic text analysis for the specific content of the study.

5. Conclusion

On the whole, the number of articles published every year is increasing steadily. The USA has great influence in this field. Simultaneously, researchers can cooperate with Yaffe K and pay attention to the frontier dynamics of CI secondary to CKD in the American Journal of Kidney Diseases. Research on CI secondary to CKD is increasingly focused on quality of life, comprehensive management, and the multidimensional influence on patients. We hope this bibliometric research helps researchers understand the field’s status and active researchers, promoting international cooperation, improving research quality, and accelerating technology availability and application.

Author contributions

Conceptualization: Yanran Chen.

Data curation: Ruiting Zhu, Xinyi Zhu, Zhaoyao Luo.

Formal analysis: Ruiting Zhu, Qiange Zhu.

Investigation: Xinyi Zhu, Qiange Zhu, Zhaoyao Luo.

Methodology: Yanran Chen, Ruiting Zhu.

Project administration: Yanran Chen, Shaohui Ma.

Supervision: Shaohui Ma.

Validation: Yanran Chen, Ruiting Zhu.

Visualization: Yanran Chen, Junya Mu, Ming Zhang.

Writing – original draft: Yanran Chen, Junya Mu.

Writing – review & editing: Yanran Chen, Ruiting Zhu, Xinyi Zhu, Qiange Zhu.

Abbreviations:

CI
cognitive impairment
CKD
chronic kidney disease
eGFR
estimated glomerular filtration rate
GC
global citation
IF
impact factor
IL-18
interleukin-18
IL-1β
interleukin-1 beta
LC
local citation
MCI
mild cognitive impairment
NLRP3
NLR family pyrin domain containing 3
TC
total citation
WOSCC
Web of Science Core Collection

The statements and opinions expressed in this article are those of the individual contributors and do not necessarily represent the views of the other editors or the publisher. Unless otherwise specified, the authors and publisher disclaim any responsibility or liability for such material.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Chen Y, Zhu R, Zhu X, Zhu Q, Luo Z, Mu J, Zhang M, Ma S. Bibliometric analysis of cognitive impairment secondary to chronic kidney disease. Medicine 2026;105:7(e47621).

YC and RZ contributed to this article equally.

Contributor Information

Yanran Chen, Email: 18280865316@163.com.

Ruiting Zhu, Email: zhuqgbetter@163.com.

Xinyi Zhu, Email: zhuqgbetter@163.com.

Qiange Zhu, Email: zhuqgbetter@163.com.

Zhaoyao Luo, Email: lzy.lawrence@stu.xjtu.edu.cn.

Junya Mu, Email: junyamu@xjtu.edu.cn.

Ming Zhang, Email: zhangming01@mail.xjtu.edu.cn.

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