While neurological conditions in chronic kidney disease patients often go undiagnosed, there is a known potential risk of cognitive impairment, stroke, seizure, and peripheral neuropathy. Chronic Renal Disease goes over risk factors and methods of prevention.
The second edition of the book Chronic Renal Disease looks at all aspects of chronic kidney disease (CKD), covering everything from treatment and management of CKD to physiology and pathophysiology of the disease. One of the book’s chapters focuses solely on neurological complications associated with CKD—including what issues are most common, what the risk factors are, and what methods of prevention are available to patients.*
While a strong correlation between renal function and cognitive function is well established, neurological conditions in CKD patients remain largely undiagnosed.
In CKD patients, the most common neurological outcomes are:
Cognitive impairment refers to “when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.” Peripheral neuropathies are “a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves),” which typically causes a feeling of numbness, pain, and/or weakness in the hands and feet.
Annual and pre-dialysis cognitive screenings must be performed in order to avoid adverse outcomes from missed cognitive impairment diagnoses. Medication noncompliance and an inability to make informed decisions regarding initiating dialysis should also be carefully examined.
In patients with CKD and end-stage renal disease (ESRD), the risk of stroke increases significantly—up to seven times as much—during dialysis initiation. Stroke risk also increases as a result of certain treatments, such as erythropoiesis-stimulating agents (ESA), which are medications that stimulate bone marrow to make red blood cells. This type of medication is typically used to treat anemia in ESRD patients.
Blood thinners, such as warfarin and dose-adjusted newer anticoagulants, have been found to be effective in preventing stroke in atrial fibrillation (irregular, rapid heartbeat) for stage 3 CKD patients. These medications, also known as anticoagulants, however, are not recommended for those with stage 4 or higher CKD.
While these neurological complications are most obvious in ESRD, their presence is likely detectable at earlier stages of CKD. An earlier diagnosis and a long-term risk management plan is necessary to optimize the outcomes for CKD patients. In doing so, there is the opportunity to reduce the impact of neurological issues at later disease stages.
*Seligera, S., & Waddy, S. P. (2019, Sept. 26). “Chapter 29 – Neurologic Complications of Chronic Kidney Disease.” Chronic Renal Disease.
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