Cognitive impairment in CKD patients: a guidance document by the CONNECT network
Authors: Bolignano Davide , Simeoni Mariadelina , Hafez Gaye , Pepin Marion , Gallo Antonio , Altieri Manuela , Liabeuf Sophie , Giannakou Konstantinos , De Ananya , Capasso Giovambattista ,   CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaborators, Capasso Giovambattista , Andrade Alexandre , Arici Mustafa , Bachmann Maie , Bailey Matthew , Barbieri Michelangela , Bobot Mickaël , Bruchfeld Annette , Arune-Bumblyte Inga , Rastenytė Daiva , Calcutta Antonello , Capolongo Giovanna , Carriazo Sol , Ceccarelli Michele , Covic Adrian Constantin , De Ananya , Delgado Pilar , Endlich Nicole , Endres Matthias , Esposito Fabrizio , Farisco Michele , Faucher Quentin , Ferreira Ana Carina , Figurek Andreja , Fouque Denis , Franssen Casper , Fridolin Ivo , Frische Sebastian , Garneata Liliana , Gesualdo Loreto , Giannakou Konstantinos , Godefroy Olivier , Golenia Aleksandra , Goumenos Dimitrios , Jiménez Eugenio Gutiérrez , Hafez Gaye , Hoorn Ewout , Silva Pedro Henrique Imenez , Izhar Raafiah , Kelly Dearbhla , Kesler Shelli , Klimkowicz-Mrowiec Aleksandra , Knauss Samuel , Kurganaite Justina , Levassort Hélène , Liabeuf Sophie , Malyszko Jolanta , Mani Laila-Yasmin , Martino Gianvito , Massy Ziad , Mayer Christopher , Mucci Armida , Mutevelic-Turkovic Alma , Nielsen Rikke , Nitsch Dorothea , Ortiz Alberto , Panagiotopoulos Vasileios , Karasavvidou Despoina , Paolisso Giuseppe , Pejušković Bojana , Pepin Marion , Perna Alessandra , Perrottelli Andrea , Pešić Vesna , Pezzella Pasquale , Rroji (Molla) Merita , Rychlík Ivan , Sakkas Giorgos , Simeoni Mariadelina , Romeo Maria José Soler , Spasovski Goce , Starčević Ana , Tedeschi Gioacchino , Trevisani Francesco , Unwin Robert , Vazelov Evgueniy , Wagner Carsten Alexander , Wagner Franca , Wanner Christoph , Wiecek Andrzej , Xu Hong , Zacchia Miriam , Zacharia Lefteris , Zecchino Irene , Zoccali Carmine , Mattace-Raso Francesco , Endlich Karl-Hans , Perico Norberto , Remuzzi Giuseppe , Trepiccione Francesco , Okusa Mark , Di Marzo Vincenzo , Blankestijn Peter , Eckardt Kai-Uwe , Konig Maximilian , Gansevoort Ron , Askari Hassan , Hansen Brian , Snaedal Sunna , Cuiban Elena , Caporusso Edoardo , Re Vincenzina Lo , Roiser Jonathan , Rosenberg Kerry , Bisecco Alvino , Denby Laura , Kulkarni Onkar Prakash , Sharma Kumar , Debnath Subrata , Jaafar Afaf , Capasso Anna , Mulholland Michele , Workeneh Biruh , Iervolino Anna , Fraser Simon , Frey-Wagner Isabelle , Pastore Annachiara , Mačiulaitis Romaldas , De Donato Antonio , Farinha Ana 
Published: October 2024

ABSTRACT
Cognitive impairment is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the Cognitive Decline in Nephro-Neurology: European Cooperative Target network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis and clinical management of CKD-related cognitive impairment. Cognitive impairment is significantly more common in CKD patients compared with the general population, particularly those undergoing haemodialysis. The development of cognitive impairment is influenced by a complex interplay of factors, including uraemic neurotoxins, electrolytes and acid–base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of cognitive impairment utilizing cognitive assessment tools, neuroimaging and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing
cognitive impairment in CKD patients through early detection, careful medication management and tailored therapeutic strategies to improve patient outcomes.