Neurological Complications in Chronic Kidney Disease: A Narrative Review of Central and Peripheral Sequelae
Objective:
This review aims to assess the current evidence for central and peripheral nervous system complications in chronic kidney disease, highlighting the epidemiology, clinical characteristics, pathophysiology, and implications for screening and management.
Background:
Neurological complications in chronic kidney disease (CKD) affect both central and peripheral systems and vary by CKD stage, dialysis modality, or transplant status. Risk factors such as age, diabetes, hypertension, uremic toxins, electrolyte imbalances, anemia, and neuroinflammation contribute to stroke, cognitive impairment, uremic encephalopathy, neuropathies, and sleep–movement disorders.
Design/Methods:
A literature review was conducted using PubMed, Scopus, and Google Scholar. Studies on CKD-related neurological complications like stroke, cognitive impairment, uremic encephalopathy, neuropathies, and restless legs syndrome were included. Key mechanisms analysed included toxin accumulation, vascular injury, oxidative stress, electrolyte disturbances, anemia, and neuroinflammation
Results:
Central Nervous System: Stroke, cognitive impairment, and acute uremic encephalopathy are common, presenting with delirium, tremors, or altered consciousness.
Neuropathy: Uremic neuropathy affects 60–90% of dialysis patients, causing sensory loss, weakness, and muscle wasting. Autonomic neuropathy may lead to orthostatic hypotension, impotence, and gastrointestinal motility disorders.
Restless Legs Syndrome: RLS is 2–3 times more common in CKD than the general population, with a prevalence of 24% in CKD and 28% in dialysis patients, impairing sleep and quality of life.
Pathophysiological Mechanisms: Neurological complications arise from toxin accumulation, vascular injury, oxidative stress, electrolyte disturbances, anemia, and chronic inflammation.
Conclusions:
Neurological complications in CKD are prevalent but often overlooked. Routine screening with MoCA for cognition, monofilament and orthostatic vitals for neuropathy and autonomic function, and IRLSSG criteria for restless legs syndrome (RLS) should be implemented. Priorities to improve patient outcomes include aggressive blood pressure and lipid control, anemia optimization, individualized dialysis prescriptions (adequacy and ultrafiltration), and assessment of transplant eligibility. Future research should focus on interventional trials targeting vascular risk reduction, toxin clearance, and neuroprotection in CKD.
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