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Anticholinergic Burden and Progression to Kidney Replacement Therapy
Agathe Mouheb1,2, Ziad A Massy3,4,5, Marie Metzger3
1Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France.
Kidney International Reports
|May 25, 2026
Summary
High anticholinergic burden significantly increases the risk of chronic kidney disease (CKD) progression to kidney replacement therapy (KRT). This highlights the need for careful medication management in CKD patients to preserve renal function.
Area of Science:
- Nephrology
- Pharmacology
- Epidemiology
Background:
- The cholinergic system plays a role in kidney health via anti-inflammatory and vasoregulatory mechanisms.
- The effect of anticholinergic medications on chronic kidney disease (CKD) progression is not well understood.
- Understanding this association is crucial for managing CKD patients and preventing disease advancement.
Purpose of the Study:
- To investigate the relationship between the burden of anticholinergic medications and the progression of CKD.
- To determine if anticholinergic burden predicts the need for kidney replacement therapy (KRT).
Main Methods:
- A prospective cohort study (CKD-REIN) enrolled nephrology outpatients with CKD (eGFR < 60 ml/min/1.73 m²).
- Anticholinergic burden was quantified using the Anticholinergic Cognitive Burden (ACB) score of all baseline medications.
- Cox proportional hazards regression models analyzed the association between anticholinergic burden and CKD progression (initiation of KRT) over 5 years.
Main Results:
- A high anticholinergic burden was independently associated with a significantly increased risk of CKD progression to KRT (HR = 1.53, 95% CI = 1.09-2.14).
- A low or moderate anticholinergic burden showed a non-significant trend towards elevated risk (HR = 1.09, 95% CI = 0.85-1.24).
- Out of 3009 patients, 647 initiated KRT during the 5-year follow-up.
Conclusions:
- A high anticholinergic burden is a significant risk factor for CKD progression.
- Disruption of cholinergic signaling may accelerate renal function decline.
- Medication review and optimization are essential components of CKD management to mitigate risks associated with anticholinergic medications.
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