慢性腎臟病與失智症之探討

Discussion on Chronic Kidney Disease and Dementia

失智症(dementia)為當前重要的醫療議題，多種致病因子已逐漸被證實，其中慢性腎臟病(chronic kidney disease)是已知會增加罹患失智症的危險因子，慢性腎臟病可透過血管傷害、內皮細胞功能障礙及尿毒素的影響而造成認知功能障礙，最終進展成失智症，嚴重影響病人的自身安全、影響末期腎臟病的治療（如配合透析、正確服藥）。失智者的照護不是僅聚焦於其本人，其周邊的環境、照顧者、醫療團隊等皆應被視為一個治療聯盟，失智者與照顧者的信任感與安全感是影響照護品質的重要因素。本篇文章將針對失智症的定義、種類、診斷、慢性腎臟病患者罹患失智症危險因子、注射紅血球生成素及鐵劑與失智症之關聯、透析患者罹患失智症盛行率、後續治療照護及照護者喘息做探討，希望藉由此篇文章提供照護者參考。

Dementia is an important medical issue at present, and a variety of pathogenic factors have been gradually confirmed. Among them, chronic kidney disease is known to increase the risk of dementia. Chronic kidney disease can cause cognitive dysfunction through vascular damage, endothelial cell dysfunction and the influence of urinary toxins, and eventually progress to dementia, which may seriously affect the patient's safety and the treatment of end-stage renal disease (such as cooperating with dialysis and take the medication correctly ). The care of people with dementia should not only focus on themselves. The treatment plan should include environmental factors, and the multidisciplinary team should include caregiver. Trust between people with dementia and caregivers and the sense of security is an important factor affecting the quality of care. This article will discuss the definition, types and diagnosis of dementia, risk factors for dementia in patients with chronic kidney disease, the association of erythropoietin and iron injections with dementia, the prevalence of dementia in dialysis patients, follow-up care and Respite Care Service . We hope this article will serve as a reference for the caregiver.