TY - JOUR
T1 - Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor
AU - Mayer, Christopher Clemens
AU - Liabeuf, Sophie
AU - Pešić, Vesna
AU - Spasovski, Goce
AU - Maciulaitis, Romaldas
AU - Bobot, Mickaël
AU - Farinha, Ana
AU - Wagner, Carsten A
AU - Unwin, Robert J
AU - Capasso, Giovambattista
AU - Bumblyte, Inga Arune
AU - Hafez, Gaye
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected]
PY - 2023/12
Y1 - 2023/12
N2 - 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
AB - 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
KW - adverse drug reactions
KW - chronic kidney disease
KW - cognitive impairment
KW - drug prescription
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U2 - 10.1093/ckj/sfad241
DO - 10.1093/ckj/sfad241
M3 - Article
SN - 2048-8505
VL - 16 (2023)
SP - 2365
EP - 2377
JO - CKJ: Clinical Kidney Journal
JF - CKJ: Clinical Kidney Journal
IS - 12
ER -