Beyond the dichotomy between controlled and naturalistic paradigms: modeling psychological constructs in cognitive neuroscience.

AKI is a common clinical syndrome characterized by a rapid (within 48 hours) decline in renal excretory function. Its etiologies are traditionally categorized into three groups: prerenal (e.g., hypovolemia, decreased cardiac output), intrinsic renal (e.g., ischemia, nephrotoxins, sepsis-induced glomerulonephritis or acute tubular necrosis), and postrenal (e.g., urinary tract obstruction) (, ). According to the KDIGO clinical practice guidelines, the diagnosis and staging of AKI are based on an increase in serum creatinine by ≥0.3 mg/dL within 48 hours, or to ≥1.5 times baseline within the prior 7 days, or sustained oliguria (<0.5 mL/kg/h) for at least 6 hours (). The incidence of AKI in intensive care units (ICUs) exceeds 50% and is associated with prolonged hospital stays and increased mortality (). AKI not only affects the kidneys themselves but can also lead to dysfunction in distant organs. Even mild and transient AKI may indicate an increased risk of both short- and long-term adverse outcomes, including new-onset or worsening chronic kidney disease (CKD), progression to end-stage renal disease, infections and sepsis, gastrointestinal bleeding, malignancy, fracture risk, and cardiovascular events (). Recent clinical studies have shown that AKI can induce both acute and chronic brain dysfunction. Such as delirium, dementia, coma, depression, and stroke. The most common manifestations include delirium and dementia (–). Among patients with AKI in ICU, the incidence of delirium ranges from 30% to 60%, which is significantly higher than that in patients without AKI. Moreover, within 1–5 years after AKI, the risk of dementia increases by 49%–64% compared with individuals without AKI, while the risk of mild cognitive impairment (MCI) increases two-to three-fold. Evidence indicates that AKI patients who develop delirium have an ICU mortality rate of approximately 40% – 55%, whereas those with cognitive impairment experience nearly a twofold higher 1-year all-cause mortality compared with patients without cognitive impairment (, ). In addition, AKI accompanied by brain dysfunction substantially increases healthcare and societal costs (, ).