CONFLICT OF INTERESTS
None.
Dear Editor,
We read with a great interest the letter by Kawada and colleagues regarding our recent publication. We are in complete agreement with their concerns. We also believe that the inter‐relationships among several levels of arterial damage, kidney function, and frailty should be used for predicting cognitive decline. Of note, cognitive capacities significantly decrease across chronic kidney disease (CKD) stages1 and the severity of renal dysfunction is independently correlated with that of cognitive impairment. Indeed, in our previous study including hypertensive and CKD patients less than 65 years of age, in every CKD stage the risk of cognitive dysfunction increased more than twofold.2 Furthermore, age and hypertension by itself were significantly associated with cognitive decline.2
It is now clear that CKD is a risk factor for cardiovascular disease. Furthermore, the combination of kidney and mental dysfunction may portend a higher risk of cardiovascular and cerebrovascular disease. In CKD patients, cognitive impairment may occur due to the presence of other additional metabolic risk factors, that is, uremia, inflammation, oxidative stress, or anemia.2 Hence, poor cognitive function is strongly associated with frailty populations around the world with adverse health outcomes.3
Arterial stiffness is an independent predictor of all‐cause and cardiovascular mortality in patients with CKD. Measures of arterial stiffness have contributed substantially to our understanding of mechanisms of kidney disease progression, are linked to decreased glomerular filtration rate, and are predictive of kidney disease progression and the patients’ cardiovascular outcome.4
We also know that arterial stiffness is one of the earliest indicators of changes in vascular wall structure and function. Pre‐frailty and frailty are associated with higher arterial stiffness.5 In addition, arterial stiffness is a sensitive predictor of cognitive impairment. Thus, it may help to explain the relationship between frailty and cardiovascular disease.5
We believe that the severity of the vessel hardness can be used as an indicator for a more aggressive treatment in an effort to prevent or delay the onset and progression of dementia in the elderly6 as well as it could be used to predict models to assess rapid kidney function deterioration. From this point of view, early treatment of arterial stiffness is beneficial and recommended.6 Finally, in frailty populations arterial stiffness may be a useful index for risk stratification, to guide tailored treatment decisions or preventive interventions.
REFERENCES
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