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This article is published as part of a supplement financially supported by the COST Action CA19127-Cognitive Decline in Nephro-Neurology: European Cooperative Target (CONNECT). P.H.I.S. and C.A.W. have been supported by the Swiss National Science Foundation-financed NCCR Kidney.CH. A.O. was supported by the FIS/Fondos FEDER [PI18/01366, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009)], Sociedad Espa~nola de Nefrologi ' a, FRIAT and Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM.

Analysis of institutional authors

Ortiz, AAuthor

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January 24, 2022
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Review

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Publicated to:NEPHROLOGY DIALYSIS TRANSPLANTATION. 37 (suppl 2): 4-13 - 2022-01-01 37(suppl 2), DOI: 10.1093/ndt/gfab216

Authors: Silva, Pedro H. Imenez; Unwin, Robert; Hoorn, Ewout J.; Ortiz, Alberto; Trepiccione, Francesco; Nielsen, Rikke; Pesic, Vesna; Hafez, Gaye; Fouque, Denis; Massy, Ziad A.; De Zeeuw, Chris, I; Capasso, Giovambattista; Wagner, Carsten A.;CONNECT Action Cognitive Decline N

Affiliations

Altinbas Univ, Fac Pharm, Dept Pharmacol, Istanbul, Turkey - Author
Ambroise Pare Univ Hosp, AP HP, Dept Nephrol, Boulogne, France - Author
Biogem Inst Mol Biol & Genet, Ariano Irpino, Italy - Author
Lyon Sud Hosp, Serv Nephrol, Pierre Benite, France - Author
Natl Ctr Competence Res NCCR Kidney CH, Zurich, Switzerland - Author
Royal Dutch Acad Art & Sci, Netherlands Inst Neurosci, Amsterdam, Netherlands - Author
UCL, Royal Free Hosp, Dept Renal Med, London, England - Author
Univ Aarhus, Dept Biomed Anat, Aarhus, Denmark - Author
Univ Autonoma Madrid, IIS Fdn Jimenez Diaz, Dept Nephrol & Hypertens, Madrid, Spain - Author
Univ Belgrade, Fac Pharm, Dept Physiol, Belgrade, Serbia - Author
Univ Campania Luigi Vanvitelli, Dept Translat Med Sci, Naples, Italy - Author
Univ Claude Bernard Lyon 1, INSERM 1060, CarMeN, Lyon, France - Author
Univ Med Ctr Rotterdam, Erasmus Med Ctr, Dept Internal Med, Rotterdam, Netherlands - Author
Univ Med Ctr Rotterdam, Erasmus Med Ctr, Dept Neurosci, Rotterdam, Netherlands - Author
Univ Paris Saclay, Univ Versailles St Quentin Yvelines, INSERM, U1018 Team 5,Ctr Rech Epidemiol & Sante Populat, Villejuif, France - Author
Univ Zurich, Inst Physiol, Zurich, Switzerland - Author
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Abstract

Metabolic acidosis, defined as a plasma or serum bicarbonate concentration <22mmol/L, is a frequent consequence of chronic kidney disease (CKD) and occurs in similar to 10-30% of patients with advanced stages of CKD. Likewise, in patients with a kidney transplant, prevalence rates of metabolic acidosis range from 20% to 50%. CKD has recently been associated with cognitive dysfunction, including mild cognitive impairment with memory and attention deficits, reduced executive functions and morphological damage detectable with imaging. Also, impaired motor functions and loss of muscle strength are often found in patients with advanced CKD, which in part may be attributed to altered central nervous system (CNS) functions. While the exact mechanisms of how CKD may cause cognitive dysfunction and reduced motor functions are still debated, recent data point towards the possibility that acidosis is one modifiable contributor to cognitive dysfunction. This review summarizes recent evidence for an association between acidosis and cognitive dysfunction in patients with CKD and discusses potential mechanisms by which acidosis may impact CNS functions. The review also identifies important open questions to be answered to improve prevention and therapy of cognitive dysfunction in the setting of metabolic acidosis in patients with CKD.

Keywords

AcidosisAssociationBase statusCerebral-blood-flowCerebrospinal-fluidChronic kidney diseaseCkdCognitive dysfunctionEcf phExpressionKlothoMetabolic-acidosisMotor functionPurkinje-cellsSerum bicarbonate

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal NEPHROLOGY DIALYSIS TRANSPLANTATION due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 10/88, thus managing to position itself as a Q1 (Primer Cuartil), in the category Urology & Nephrology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 3.51. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 4.32 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 10.56 (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-02, the following number of citations:

  • WoS: 10
  • Scopus: 19
  • Europe PMC: 7
  • Google Scholar: 1

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-02:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 53.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 57 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 47.6.
  • The number of mentions on the social network X (formerly Twitter): 74 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Denmark; France; Italy; Netherlands; Switzerland; Turkey; United Kingdom.