Neurologic Complications of Chronic Kidney Disease

Neurologic outcomes in CKD patients are pervasive; most common are cognitive impairment, stroke, and peripheral neuropathies. Despite a strong graded association between measures of renal function and cognitive function, cognitive impairment in CKD patients is largely undiagnosed. Annual and predialysis cognitive screening is critical to avoid adverse outcomes of missed diagnoses of cognitive impairment: medication noncompliance and inability to make informed decisions regarding initiating dialysis. Cerebrovascular disease, neurodegenerative disease, and inflammation contribute to a CKD model of accelerated vascular cognitive impairment. Risk of stroke increases significantly in CKD and ESRD patients, up to 7-fold during the month of dialysis initiation. Aggressive treatment with erythropoiesis-stimulating agents increases stroke risk appreciably. For stroke prevention in atrial fibrillation, warfarin and dose-adjusted newer anticoagulants appear effective in stage 3 CKD patients but are unproven or contraindicated in CKD stage 4 or higher. Management of uremic polyneuropathy, mononeuropathies, and uremic pruritus is described in this chapter.