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Review
. 2025 Mar 13;40(Supplement_2):ii28-ii36.
doi: 10.1093/ndt/gfae264.

Care pathways for patients with cognitive impairment and chronic kidney disease

Marion Pépin  1   2 , Konstantinos Giannakou  3 , Hélène Levassort  1   2 , Ana Farinha  4 , Mickaël Bobot  5   6 , Vincenzina Lo Re  7 , Aleksandra Golenia  8 , Jolanta Małyszko  9 , Francesco Mattace-Raso  10 , Aleksandra Klimkowcz-Mrowiec  11 , Liliana Garneata  12   13 , Evgueniy Vazelov  14 , Elena Stepan  12   15 , Giovanna Capolongo  16 , Ziad Massy  1   17   18 , Andrzej Wiecek  19 ; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaborators
Collaborators, Affiliations
Review

Care pathways for patients with cognitive impairment and chronic kidney disease

Marion Pépin et al. Nephrol Dial Transplant. .

Abstract

Various epidemiological datasets and pathophysiological hypotheses have highlighted a significant link between chronic kidney disease (CKD) and cognitive impairment (CI); each condition can potentially exacerbate the other. Here, we review the mutual consequences of CKD and CI on health outcomes and care pathways and highlight the complexities due to the involvement of different specialists. Our narrative review covers (i) the burden of CI among patients with CKD, (ii) the impact of CI on kidney health, (iii) access to kidney replacement therapy for people with CI, (iv) resources in cognitive care and (v) potential models for integrated 'nephro-cognitive' care. CI (ranging from mild CI to dementia) has a significant impact on older adults, with a high prevalence and a strong association with CKD. Furthermore, CI complicates the management of CKD and leads to a higher mortality rate, poorer quality of life and higher healthcare costs. Due to difficulties in symptom description and poor adherence to medical guidelines, the presence of CI can delay the treatment of CKD. Access to care for patients with both CKD and CI is hindered by physical, cognitive and systemic barriers, resulting in less intensive, less timely care. Multidisciplinary approaches involving nephrologists, geriatricians, neurologists and other specialists are crucial. Integrated care models focused on person-centred approaches, shared decision-making and continuous co-management may improve outcomes. Future research should focus on the putative beneficial effects of these various strategies on both clinical and patient-reported outcomes.

Keywords: care access; care pathways; chronic kidney disease; co-management; cognitive impairment.

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Conflict of interest statement

Authors do not have any conflict of interest relating with this manuscript. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Figures

Figure 1:
Figure 1:
Proposed steps for the care management of patients with CKD undergoing CI.
Figure 2:
Figure 2:
Care pathways for patients with CKD who develop cognitive impairment and for cognitively impaired patients with CKD: a call for multidisciplinarity and co-management.
See this image and copyright information in PMC

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