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    Chronic kidney disease and neurological disorders: are uraemic toxins the missing piece of the puzzle?
    (Nephrol Dial Transplant, 2021) Pepin, Marion; Franssen, Casper F.M; Viggiano, Davide; Carriazo, Sol; Gansevoort, Ron T.; Gesualdo, Loreto; Malyszko, Jolanta; Mayer, Christopher; Nitsch, Dorothea; Ortiz, Alberto; Pesic, Vesna; Wiecek, Andrzej; Massy, Ziad A.; (Cognitive Decline in Nephro-Neurology European Cooperative Target
    Chronic kidney disease (CKD) perturbs the crosstalk with others organs, with the interaction between the kidneys and the heart having been studied most intensively. However, a growing body of data indicates that there is an association between kidney dysfunction and disorders of the central nervous system. In epidemiological studies, CKD is associated with a high prevalence of neurological complications, such as cerebrovascular disorders, movement disorders, cognitive impairment and depression. Along with traditional cardiovascular risk factors (such as diabetes, inflammation, hypertension and dyslipidaemia), non-traditional risk factors related to kidney damage (such as uraemic toxins) may predispose patients with CKD to neurological disorders. There is increasing evidence to show that uraemic toxins, for example indoxyl sulphate, have a neurotoxic effect. A better understanding of factors responsible for the elevated prevalence of neurological disorders among patients with CKD might facilitate the development of novel treatments. Here, we review (i) the potential clinical impact of CKD on cerebrovascular and neurological complications, (ii) the mechanisms underlying the uraemic toxins’ putative action (based on pre-clinical and clinical research) and (iii) the potential impact of these findings on patient care.
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    Cognitive decline related to chronic kidney disease as an exclusion factor from kidney transplantation: results from an international survey
    (2024) Farisco, Michele; Blumblyte, Inga, A.; Franssen, Casper; Nitsch, Dorothea; Zecchino, Irene; Capasso, Giovambattista; Hafez, Gaye
    Background and hypothesis: There seems to be a lack of consensus on the necessity and the modality of psychological and specifically cognitive assessment of candidates for kidney transplantation. Both points are often delegated to individual hospitals/centres, whereas international guidelines are inconsistent. We think it is essential to investigate professionals' opinions to advance towards a consistent clinical practice. Methods: This paper presents the results of an international survey among clinical professionals, mainly nephrologists from the CONNECT (Cognitive decline in Nephro-Neurology: European Cooperative Target) network and beyond (i.e. from personal contacts of CONNECT members). The survey investigated their opinions about the question of whether cognitive decline in patients with chronic kidney disease may affect their eligibility for kidney transplantation. Results: Our results show that most clinicians working with patients affected by chronic kidney disease think that cognitive decline may challenge their eligibility for transplantation despite data that suggest that, in some patients, cognitive problems improve after kidney transplantation. Conclusion: We conclude that three needs emerge as particularly pressing: defining agreed-on standards for a multifaceted and multifactorial assessment (i.e. including both clinical/medical and psychosocial factors) of candidates with chronic kidney disease to kidney transplantation; further investigating empirically the causal connection between chronic kidney disease and cognition; and further investigating empirically the possible partial reversibility of cognitive decline after kidney transplantation.
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    Drugs with a negative impact on cognitive functions (Part 2): drug classes to consider while prescribing in CKD patients
    (2023) Hafez, Gaye; Malyszko, Jolanta; Golenia, Aleksandra; Klimkowicz-Mrowiec, Aleksandra; Ferreira, Ana Carina; Arıcı, Mustafa; Bruchfeld, Annette; Nitsch, Dorothea; Massy, Ziad A.; Pepin, Marion; Capasso, Giovambattista; Mani, Laila-Yasmin; Liabeuf, Sophie
    There is growing evidence that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment, especially due to vascular damage, blood-brain barrier disruption and uremic toxins. Given the presence of multiple comorbidities, the medication regimen of CKD patients often becomes very complex. Several medications such as psychotropic agents, drugs with anticholinergic properties, GABAergic drugs, opioids, corticosteroids, antibiotics and others have been linked to negative effects on cognition. These drugs are frequently included in the treatment regimen of CKD patients. The first review of this series described how CKD could represent a risk factor for adverse drug reactions affecting the central nervous system. This second review will describe some of the most common medications associated with cognitive impairment (in the general population and in CKD) and describe their effects.