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Updated: May 22, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Care pathways for patients with cognitive impairment and chronic kidney disease
Marion Pépin1,2, Konstantinos Giannakou3, Hélène Levassort1,2
1INSERM Unit 1018, Team 5, CESP, Hôpital Paul Brousse, Paris-Saclay University and Versailles Saint-Quentin-en-Yvelines University (UVSQ), Villejuif, France.
Insights
Chronic kidney disease (CKD) and cognitive impairment (CI) negatively impact each other, complicating patient care and outcomes. Integrated, multidisciplinary approaches are essential for managing these interconnected conditions effectively.
Area of Science:
- Nephrology
- Neurology
- Geriatrics
- Public Health
Background:
- Chronic kidney disease (CKD) and cognitive impairment (CI) are increasingly recognized as interconnected conditions.
- Epidemiological data and pathophysiological studies highlight a bidirectional relationship where each condition can worsen the other.
- CI, ranging from mild impairment to dementia, is highly prevalent in older adults with CKD, significantly impacting their health and care.
Purpose of the Study:
- To review the mutual consequences of CKD and CI on health outcomes and care pathways.
- To explore the complexities of managing patients with both CKD and CI, involving multiple medical specialists.
- To identify potential models for integrated 'nephro-cognitive' care.
Main Methods:
- This study is a narrative review of existing epidemiological datasets and pathophysiological hypotheses.
- The review synthesizes information on the burden of CI in CKD patients, CI's impact on kidney health, and access to kidney replacement therapy.
- It also examines cognitive care resources and proposes integrated care models.
Main Results:
- CI complicates CKD management, leading to delayed treatment, higher mortality, reduced quality of life, and increased healthcare costs.
- Patients with both CKD and CI face physical, cognitive, and systemic barriers to accessing timely and intensive care.
- Multidisciplinary collaboration among nephrologists, geriatricians, neurologists, and other specialists is crucial.
Conclusions:
- Integrated care models emphasizing person-centered approaches, shared decision-making, and co-management are vital for improving outcomes in patients with CKD and CI.
- Future research should investigate the effectiveness of these integrated strategies on clinical and patient-reported outcomes.
- Addressing the interplay between CKD and CI requires a coordinated, multidisciplinary approach to optimize patient care and well-being.
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.
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