Neurological complications in chronic kidney disease

Abstract

Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

Keywords: Chronic kidney disease; autonomic neuropathy; cognitive dysfunction; neurological complications; peripheral neuropathy; uraemic encephalopathy; uraemic neuropathy.

Figure 1.

Flow chart of the exposures in CKD associated with central nervous system damage.

Figure 2.

(a) Electroencephalogram of a chronic kidney disease patient who presented with drowsiness and confusion. Triphasic waves as typically seen in uraemic encephalopathy are highlighted in blue. (b) Electroencephalogram of a healthy patient. Normal background alpha rhythm is highlighted in red.

Figure 3.

Clinical features of advanced uraemic neuropathy: (a) atrophy of musculature in the distal lower limb, (b) ulceration and (c) amputation.