Portal de Periódicos da CAPES

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

2023; Oxford University Press; Volume: 16; Issue: 12 Linguagem: Inglês

10.1093/ckj/sfad241

2048-8513

Sophie Liabeuf, Vesna Pešić, Goce Spasovski, Romaldas Mačiulaitis, Mickaël Bobot, Ana Farinha, Carsten A. Wagner, Robert J. Unwin, Giovambattista Capasso, Inga Arūnė Bumblytė, Gaye Hafez, Giovambattista Capasso, Alexandre Andrade, Maie Bachmann, Inga Arūnė Bumblytė, Adrian Covic, Pilar Delgado, Nicole Endlich, Andreas Engvig, Denis Fouque, Casper Franssen, Sebastian Frische, Liliana Gârneaţă, Loreto Gesualdo, Konstantinos Giannakou, Dimitrios Goumenos, Ayşe Tuğba Kartal, Sophie Liabeuf, Laila-Yasmin Mani, Hans-Peter Marti, Christopher Mayer, Rikke Nielsen, Vesna Pešić, Merita Rroji, Giorgos K. Sakkas, Goce Spasovski, Kate Stevens, Evgueniy Vazelov, Davide Viggiano, Lefteris Zacharia, Ana Carina Ferreira, Jolanta Małyszko, Ewout J. Hoorn, Andreja Figurek, Robert J. Unwin, Carsten A. Wagner, Christoph Wanner, Annette Bruchfeld, Marion Pépin, Andrzej Więcek, Dorothea Nitsch, Ivo Fridolin, Gaye Hafez, María José Soler Romeo, Michelangela Barbieri, Bojan Batinić, Laura Carrasco, Sol Carriazo, Ron T. Gansevoort, Gianvito Martino, Francesco Mattace‐Raso, Ionuţ Nistor, Alberto Ortíz, Giuseppe Paolisso, Daiva Rastenytė, Gabriel Ștefan, Gioacchino Tedeschi, Ziad A. Massy, Boris Bikbov, Karlhans Endlich, Olivier Godefroy, Anastassia Kossioni, Justina Kurganaite, Norberto Perico, Giuseppe Remuzzi, Tomasz Grodzicki, Francesco Trepiccione, Carmine Zoccali, Mustafa Arıcı, Peter J. Blankestijn, Kai‐Uwe Eckardt, Danilo Fliser, Eugenio Gutiérrez Jiménez, Maximilian König, Ivan Rychlík, Michela Deleidi, György Reusz, Michele Farisco, Norberto Perico, Pedro Imenez Silva, Mickaël Bobot, Aleksandra Golenia, Alessandra F. Perna, Alma Idrizi, Brian Bekker Hansen, Mariadelina Simeoni,

Neurological Disorders and Treatments

ABSTRACT 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.