Measurement of the defects in mental function caused by uremia is also made difficult by the confounding effects of age, personal background, and other illnesses. Not knowing which uremic solutes are toxic limits our ability to improve therapy. The contribution of retained solutes to the illness experienced by dialysis patients is difficult to dissect, but we believe it is large. We know that if dialysis is withheld, accumulation of waste solutes will cause confusion, coma, and then death.
Meyer TW, Hostetter TH. Approaches to Uremia. Journal of the American Society of Nephrology : JASN. 2014;25(10):2151-2158.
In studying the effects of uremia on mental function, we must also consider how much function will be improved by the reductions in solute levels we are able to achieve. It is worth considering what would be the effect on mental function of reducing levels of a known neuroactive compound, such as ethanol. Reducing very high ethanol levels by half could restore orientation in a stuporous person, analogous to the effect of initiating dialysis in a severely uremic patient.
Common features of uremia
Neural and Muscular Endocrine and Metabolic
Loss of energy Amenorrhea and sexual dysfunction
Decreased mental acuity Insulin resistancea
Anorexia and nausea Reduced resting energy expenditure
Restless legs Increased protein/muscle catabolism
Defective taste and smell Other
Peripheral neuropathy Pruritus
Sleep disturbances Decreased red cell survivala
Reduced muscle membrane potential Platelet dysfunctiona