Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor

People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patien...

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Bibliographic Details
Published in:Clinical kidney journal 2023-12, Vol.16 (12), p.2365-2377
Main Authors: Liabeuf, Sophie, Pešić, Vesna, Spasovski, Goce, Maciulaitis, Romaldas, Bobot, Mickaël, Farinha, Ana, Wagner, Carsten A, Unwin, Robert J, Capasso, Giovambattista, Bumblyte, Inga Arune, Hafez, Gaye
Format: Article
Language:English
Subjects:
Chronic kidney failure
Comorbidity
Complications and side effects
Drugs
Human health and pathology
Life Sciences
Medical research
Medicine, Experimental
Risk factors
Tissues and Organs
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Summary:People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood–brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics. Graphical Abstract Graphical Abstract
ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfad241