Chemotherapy-related cognitive impairment and kidney dysfunction

Abstract

Cancer and kidney diseases (KD) intersect in many ways resulting in worse outcomes. Both conditions are correlated with cognitive impairment, which can be exacerbated in cancer patients by known effects of many antineoplastic drugs on cognition, leading to a phenomenon known as chemotherapy-related cognitive impairment (CRCI). This manifests as poor attention span, disturbed short-term memory, and general mental sluggishness. This literature review explores CRCI and investigates the potential impact of KD on this phenomenon. Additionally, we highlight the shared pathogenetic mechanisms (including neurotoxicity, neuroinflammation, oxidative stress, vascular disease, electrolyte, and acid-base imbalances), clinical presentation and imaging findings between cognitive impairment in KD and CRCI. The disruption of the blood-brain barrier might be a key mechanism for increased brain permeability to anticancer drugs in nephropathic patients with cancer. Based on existing knowledge, we found a potential for heightened neurotoxicity of antineoplastic drugs and a synergistic potentiation of cognitive impairment in cancer patients with KD. However, further translational research is urgently required to validate this hypothesis.

Keywords: anticancer drugs; blood–brain barrier; chemotherapy-related cognitive impairment; chronic kidney disease; neurotoxicity.

Figure 1:

The figure highlights the shared clinical features of CRCI and KD-related CI. Created in BioRender. Hafez, G. (2024). https://BioRender.com/s43o058.

Figure 2:

The figure illustrates the common pathogenetic mechanisms of CRCI and KD-related CI, while also identifying additional KD factors contributing to cognitive decline. Created in BioRender. Hafez, G. (2024) https://BioRender.com/p20v902.

Figure 3:

The figure highlights similar structural and functional neuroimaging findings in both CRCI and KD-related CI. Created in BioRender. Hafez, G. (2024) https://BioRender.com/w92g921.