Cognitive impairment in CKD patients: a guidance document by the CONNECT network

Abstract Cognitive impairment (CI) is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the CONNECT network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis, and clinical management of CKD-related CI. CI is significantly more common in CKD patients compared to the general population, particularly those undergoing haemodialysis. The development of CI is influenced by a complex interplay of factors, including uremic 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 CI, 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 CI in CKD patients through early detection, careful medication management, and tailored therapeutic strategies to improve patient outcomes.