Faculty of Medicine

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    Item type:Publication,
    Cognitive impairment in CKD patients: a guidance document by the CONNECT network
    (Oxford University Press (OUP), 2024-09)
    Bolignano, Davide
    ;
    Simeoni, Mariadelina
    ;
    Hafez, Gaye
    ;
    Pepin, Marion
    ;
    Gallo, Antonio
    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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    Item type:Publication,
    Cognitive decline related to chronic kidney disease as an exclusion factor from kidney transplantation: results from an international survey
    (Oxford University Press (OUP), 2024-04-13)
    Farisco, Michele
    ;
    Blumblyte, Inga A
    ;
    Franssen, Casper
    ;
    Nitsch, Dorothea
    ;
    Zecchino, Irene
    <jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Background and hypothesis</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>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.</jats:p> </jats:sec>