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Drugs with a negative impact on cognitive functions (part 3): antibacterial agents in patients with chronic kidney disease

2024; Oxford University Press; Volume: 17; Issue: 8 Linguagem: Inglês

10.1093/ckj/sfae174

2048-8513

Sophie Liabeuf, Gaye Hafez, Vesna Pešić, Goce Spasovski, Mickaël Bobot, Romaldas Mačiulaitis, Inga Arūnė Bumblytė, Ana Carina Ferreira, Ana Farinha, Jolanta Małyszko, Marion Pépin, Ziad A. Massy, Robert J. Unwin, Giovambattista Capasso, Laila‐Yasmin Mani, Giovambattista Capasso, Alexandre Andrade, Mustafa Arici, Maie Bachmann, Matthew A. Bailey, Michelangela Barbieri, Mickaël Bobot, Annette Bruchfeld, Inga Arūnė Bumblytė, Antonello Calcutta, Giovanna Capolongo, Sol Carriazo, Michele Ceccarelli, Adrian Covic, Ananya De, Pilar Delgado, Nicole Endlich, Matthias Endres, Fabrizio Esposito, Michele Farisco, Quentin Faucher, Ana Carina Ferreira, Andreja Figurek, Denis Fouque, Casper Franssen, Ivo Fridolin, Sebastian Frische, Liliana Gârneaţă, Loreto Gesualdo, Konstantinos Giannakou, Olivier Godefroy, Aleksandra Golenia, Dimitrios Goumenos, Agnė Gryguc, Eugenio Gutiérrez Jiménez, Gaye Hafez, Ewout J. Hoorn, Pedro Henrique Imenez Silva, Raafiah Izhar, Dearbhla Kelly, Shelli R. Kesler, Aleksandra Klimkowicz‐Mrowiec, Samuel Knauß, Justina Kurganaite, Hélène Levassort, Sophie Liabeuf, Jolanta Małyszko, Laila-Yasmin Mani, Gianvito Martino, Ziad A. Massy, Christopher Mayer, Armida Mucci, Alma Mutevelić-Turković, Rikke Nielsen, Dorothea Nitsch, Alberto Ortíz, Vasileios Panagiotopoulos, Giuseppe Paolisso, Bojana Pejušković, Marion Pépin, Alessandra F. Perna, Andrea Perrottelli, Vesna Pešić, Pasquale Pezzella, Merita Rroji, Ivan Rychlík, Giorgos K. Sakkas, Mariadelina Simeoni, María José Soler Romeo, Goce Spasovski, Ana Starčević, Gioacchino Tedeschi, Francesco Trevisani, Robert J. Unwin, Evgueniy Vazelov, Carsten A. Wagner, Franca Wagner, Christoph Wanner, Andrzej Więcek, Hong Xu, Miriam Zacchia, Lefteris Zacharia, Irene Zecchino, Carmine Zoccali, Francesco Mattace‐Raso, Karlhans Endlich, Norberto Perico, Giuseppe Remuzzi, Francesco Trepiccione, Mark D. Okusa, Vincenzo Di Marzo, Peter J. Blankestijn, Kai‐Uwe Eckardt, Maximilian König,

Pharmacological Effects and Toxicity Studies

ABSTRACT The relationship between chronic kidney disease (CKD) and cognitive function has received increased attention in recent years. Antibacterial agents (ABs) represent a critical component of therapy regimens in patients with CKD due to increased susceptibility to infections. Following our reviewing work on the neurocognitive impact of long-term medications in patients with CKD, we propose to focus on AB-induced direct and indirect consequences on cognitive function. Patients with CKD are predisposed to adverse drug reactions (ADRs) due to altered drug pharmacokinetics, glomerular filtration decline, and the potential disruption of the blood–brain barrier. ABs have been identified as a major cause of ADRs in vulnerable patient populations. This review examines the direct neurotoxic effects of AB classes (e.g. beta-lactams, fluoroquinolones, aminoglycosides, and metronidazole) on the central nervous system (CNS) in patients with CKD. We will mainly focus on the acute effects on the CNS associated with AB since they are the most extensively studied effects in CKD patients. Moreover, the review describes the modulation of the gut microbiota by ABs, potentially influencing CNS symptoms. The intricate brain–gut–kidney axis emerges as a pivotal focus, revealing the interplay between microbiota alterations induced by ABs and CNS manifestations in patients with CKD. The prevalence of antibiotic-associated encephalopathy in patients with CKD undergoing intravenous AB therapy supports the use of therapeutic drug monitoring for ABs to reduce the number and seriousness of ADRs in this patient population. In conclusion, elucidating AB-induced cognitive effects in patients with CKD demands a comprehensive understanding and tailored therapeutic strategies that account for altered pharmacokinetics and the brain–gut–kidney axis.