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CKD patients exhibit reduced performance in memory, attention, language, visuospatial abilities and executive functions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Discussion<\/jats:title><jats:p>Contributing factors include uraemic toxins, structural brain changes, blood\u2013brain barrier dysfunction, anaemia and comorbidities like diabetes mellitus. Malnutrition, affecting nearly half of CKD patients, exacerbates cognitive decline through inflammation, oxidative stress and protein\u2010energy wasting. Nutritional deficiencies, particularly in protein, vitamin D, B vitamins, omega\u20103 fatty acids and antioxidants, are linked to impaired cognition. Emerging evidence highlights the role of the gut\u2013brain axis, with gut\u2010derived uraemic toxins and microbiome alterations contributing to cognitive dysfunction. Processed foods and microplastics further compound risks by promoting inflammation and neurotoxicity. Dialysis and kidney transplantation offer opportunities for cognitive recovery, though challenges remain, particularly in haemodialysis patients. Nutritional interventions, including tailored protein intake, micronutrient supplementation and dietary counselling, are critical for mitigating cognitive decline. Addressing CKD comorbidities, such as anaemia and diabetes through targeted nutritional and pharmacological strategies, improves outcomes. Integrating psychological and social support enhances quality of life, given the high prevalence of anxiety and depression in CKD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Future research should focus on personalized nutrition, gut microbiota modulation and routine cognitive assessments to optimise care. 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