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    Cognitive impairment in CKD patients: a guidance document by the CONNECT network
    (2025) Bolignano, Davide; Simeoni, Mariadelina; Hafez, Gaye; Pepin, Marion; Gallo, Antonio; Altieri, Manuela; Liabeuf, Sophie; Giannakou, Konstantinos; De, Ananya; Capasso, Giovambattista
    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.
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    Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease
    (Frontiers Media SA, 2023) Giannakou, Konstantinos; Golenia, Aleksandra; Liabeuf, Sophie; Malyszko, Jolanta; Mattace-Raso, Francesco; Farinha, Ana; Spasovski, Goce; Hafez, Gaye; Wiecek, Andrzej; Capolongo, Giovanna; Capasso, Giovambattista; Massy, Ziad A.
    Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies’ limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.