Cognitive impairment in patients on dialysis: can we prevent it?

J Nephrol. 2024 Sep;37(7):1813-1820. doi: 10.1007/s40620-024-02093-5. Epub 2024 Sep 21.

Abstract

Chronic kidney disease (CKD) is among the leading causes of morbidity and mortality as it affects more than 10% of the global adult population. Cognitive impairment has a positive correlation with the stage of CKD. It has been recorded in more than half of CKD patients undergoing kidney replacement therapy. The assessment of cognitive function in dialysis patients presents challenges due to various patient limitations. Such a common debilitating comorbidity of CKD has no approved treatment option, highlighting the importance of preventive measures and screening modalities. Erythropoietin therapy, exercise training, cognitive stimulation or behavioral therapies, alterations in dialysis frequency, dialysate cooling and kidney transplantation have been proposed as potential preventive and/or therapeutic options with variable efficiency at a clinical level. Regular screening, such as yearly, for cognitive impairment in maintenance dialysis patients is not only beneficial for timely and accurate diagnosis but also crucial for effective management and improved patient care. However, current practices face challenges, including the absence of validated tools specific for kidney failure and complications arising from patient conditions.

Keywords: Chronic kidney disease; Cognitive impairment; Dementia; Kidney failure; Kidney replacement therapy.

Publication types

  • Review

MeSH terms

  • Cognition
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / etiology
  • Cognitive Dysfunction* / prevention & control
  • Erythropoietin / therapeutic use
  • Humans
  • Kidney Transplantation
  • Renal Dialysis* / adverse effects
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / therapy
  • Risk Factors

Substances

  • Erythropoietin