{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:02:14Z","timestamp":1789570934681,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Cognitive impairment is increasingly recognized as a frequent and clinically significant complication of chronic kidney disease (CKD). Across the CKD spectrum, patients commonly exhibit a cognitive profile dominated by executive dysfunction and slowed processing speed, reflecting cumulative vascular, metabolic, and systemic burden. Cognitive impairment is not merely an epiphenomenon of aging but a modifier of clinical trajectory, with implications for treatment adherence, decision-making capacity, dialysis planning, transplantation, and mortality risk. This narrative review synthesizes current evidence regarding epidemiology, domain-specific cognitive patterns, risk modifiers, nutritional determinants, and clinical consequences across predialysis and dialysis populations. We discuss executive\u2013attentional dysfunction and the interaction among kidney dysfunction, vascular burden, depressive symptoms, nutritional status, and cognitive vulnerability. Particular emphasis is placed on pragmatic cognitive assessment and potentially modifiable contributors, including anemia, nutritional deficiencies, dietary patterns, medication-related effects, and dialysis-related hemodynamic instability. Brief screening approaches combining global and executive-function tools may facilitate early identification of clinically meaningful impairment. Integrating cognitive and nutritional assessment into routine CKD care may improve risk stratification, individualized management, and clinical decision-making while identifying potential targets for prevention and intervention.<\/jats:p>","DOI":"10.3390\/nu18183035","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:50:27Z","timestamp":1789566627000},"page":"3035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive Impairment Across the Spectrum of Chronic Kidney Disease: Clinical Characteristics and Implications for Practice\u2014Is There a Role for Medical Nutritional Therapy?"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2045-3781","authenticated-orcid":false,"given":"Mihaela","family":"Neicu","sequence":"first","affiliation":[{"name":"Clinical Hospital of Nephrology \u201cDr. Carol Davila\u201d, 010731 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Verzan","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Nephrology \u201cDr. Carol Davila\u201d, 010731 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3525-9253","authenticated-orcid":false,"given":"Adrian","family":"Dusa","sequence":"additional","affiliation":[{"name":"Faculty of Sociology and Social Work, University of Bucharest, 050663 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Stepan","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis, \u201cSf Ioan\u201d Clinical Emergency Hospital, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Nephrology, \u201cDr Carol Davila\u201d Teaching Hospital of Nephrology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0850-3836","authenticated-orcid":false,"given":"Cristian Iuliu Mihail","family":"Iorga","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Nephrology \u201cDr. Carol Davila\u201d, 010731 Bucharest, Romania"},{"name":"Department of Surgery, \u201cDr Carol Davila\u201d Teaching Hospital of Nephrology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geanina","family":"Beldea","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Nephrology \u201cDr. Carol Davila\u201d, 010731 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Simtea","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Nephrology \u201cDr. Carol Davila\u201d, 010731 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Garneata","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Nephrology \u201cDr. Carol Davila\u201d, 010731 Bucharest, Romania"},{"name":"Department of Nephrology, \u201cDr Carol Davila\u201d Teaching Hospital of Nephrology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","unstructured":"GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395, 709\u2013733."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Berger, I., Wu, S., Masson, P., Kelly, P.J., Duthie, F.A., Whiteley, W., Parker, D., Gillespie, D., and Webster, A.C. (2016). Cognition in chronic kidney disease: A systematic review and meta-analysis. BMC Med., 14.","DOI":"10.1186\/s12916-016-0745-9"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1159\/000338135","article-title":"Chronic kidney disease and cognitive impairment: A systematic review and meta-analysis","volume":"35","author":"Etgen","year":"2012","journal-title":"Am. J. Nephrol."},{"key":"ref_4","first-page":"157","article-title":"Cognitive disorders and dementia in chronic kidney disease","volume":"9","author":"Bugnicourt","year":"2013","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.2215\/CJN.01090210","article-title":"Prevalence and correlates of cognitive impairment in hemodialysis patients: The Frequent Hemodialysis Network trials","volume":"5","author":"Larive","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1053\/j.ajkd.2014.07.009","article-title":"Cognitive function and all-cause mortality in maintenance hemodialysis patients","volume":"65","author":"Drew","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1136\/jnnp-2022-330347","article-title":"Cognitive performance is associated with glomerular filtration rate in patients with chronic kidney disease: Results from the CKD-REIN cohort","volume":"94","author":"Levassort","year":"2023","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1053\/j.ajkd.2016.01.026","article-title":"Cognitive impairment and progression of CKD","volume":"68","author":"Yaffe","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1093\/ndt\/gfx314","article-title":"Prevalence and patterns of cognitive impairment in adult hemodialysis patients: The COGNITIVE-HD study","volume":"33","author":"Wong","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/nep.13448","article-title":"Quantifying cognitive dysfunction across the spectrum of end-stage kidney disease: A systematic review and meta-analysis","volume":"24","author":"Vanderlinden","year":"2019","journal-title":"Nephrology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.3233\/JAD-180767","article-title":"Cognitive impairment is associated with mortality in hemodialysis patients","volume":"66","author":"Angermann","year":"2018","journal-title":"J. Alzheimers Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"23265","DOI":"10.1038\/s41598-024-74420-6","article-title":"Association of chronic kidney disease with cognitive impairment risk in middle-aged and older adults: The first longitudinal evidence from CHARLS","volume":"14","author":"Shang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Li, T., Hu, Z., Qiao, L., Wu, Y., and Ye, T. (2024). Chronic kidney disease and cognitive performance: NHANES 2011\u20132014. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04917-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1093\/ndt\/gfab338","article-title":"Chronic kidney disease, physical activity and cognitive function in older adults: Results from the National Health and Nutrition Examination Survey (2011\u20132014)","volume":"37","author":"Chu","year":"2022","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1093\/ndt\/gfv213","article-title":"Effect of a single dialysis session on cognitive function in CKD5D patients: A prospective clinical study","volume":"30","author":"Schneider","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e70997","DOI":"10.1002\/brb3.70997","article-title":"Combined influence of depressive symptoms and estimated glomerular filtration rate on cognition decline in US adults","volume":"15","author":"Yang","year":"2025","journal-title":"Brain Behav."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1053\/j.ajkd.2010.04.018","article-title":"Depression and cognitive function in maintenance hemodialysis patients","volume":"56","author":"Agganis","year":"2010","journal-title":"Am. J. Kidney Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Iorga, C., Iorga, C.R., Andreiana, I., Stancu, S.H., Bengulescu, I., and Strambu, V. (2024). Management and Outcomes for Peritoneal Dialysis Patients Diagnosed with Abdominal Hernias. Life, 14.","DOI":"10.3389\/fendo.2023.1191914"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3747\/pdi.2014.00213","article-title":"Risk of dementia in peritoneal dialysis patients compared with hemodialysis patients","volume":"35","author":"Wolfgram","year":"2015","journal-title":"Perit. Dial. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"sfae210","DOI":"10.1093\/ckj\/sfae312","article-title":"Addressing cognitive impairment in peritoneal dialysis: A systematic review and meta-analysis of prevalence, risk factors, and outcomes","volume":"17","author":"Aiumtrakul","year":"2024","journal-title":"Clin. Kidney J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8224","DOI":"10.1038\/srep08224","article-title":"Comparison of dementia risk between end stage renal disease patients with hemodialysis and peritoneal dialysis\u2014A population based study","volume":"5","author":"Lin","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_22","first-page":"e934282","article-title":"Cognitive Dysfunction and Health-Related Quality of Life in Patients with ESRD Undergoing Hemodialysis in Comparison with Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study","volume":"28","author":"Zeng","year":"2022","journal-title":"Med. Sci. Monit."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1053\/j.ajkd.2010.11.026","article-title":"Cognitive impairment in peritoneal dialysis patients","volume":"57","author":"Kalirao","year":"2011","journal-title":"Am. J. Kidney Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.3233\/JAD-180498","article-title":"Associations of chronic kidney disease markers with cognitive function: A 12-year follow-up study","volume":"70","author":"Sacre","year":"2019","journal-title":"J. Alzheimers Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"248","DOI":"10.2215\/CJN.02660310","article-title":"Vascular risk factors and cognitive impairment in chronic kidney disease: The Chronic Renal Insufficiency Cohort (CRIC) study","volume":"6","author":"Xie","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kurella Tamura, M., Vittinghoff, E., Yang, J., Go, A.S., Seliger, S.L., Kusek, J.W., Lash, J., Cohen, D.L., Simon, J., and Batuman, V. (2016). Anemia and risk for cognitive decline in chronic kidney disease. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0226-6"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"108303","DOI":"10.1016\/j.jdiacomp.2022.108303","article-title":"Chronic kidney disease and cognitive decline in patients with type 2 diabetes at elevated cardiovascular risk","volume":"36","author":"Verhagen","year":"2022","journal-title":"J. Diabetes Complicat."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/jgs.19283","article-title":"The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment","volume":"73","author":"Mouheb","year":"2025","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1093\/ndt\/gfad244","article-title":"A new approach for cognitive impairment pattern in chronic kidney disease","volume":"39","author":"Levassort","year":"2024","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1093\/ndt\/gfac303","article-title":"Subclinical cognitive impairment in chronic kidney disease is associated with frailty and reduced quality of life","volume":"38","author":"Greinert","year":"2023","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Trzepacz, P.T., Hochstetler, H., Wang, S., Walker, B., Saykin, A.J., and Alzheimer\u2019s Disease Neuroimaging Initiative (2015). Relationship between the Montreal Cognitive Assessment and Mini-Mental State Examination for assessment of mild cognitive impairment in older adults. BMC Geriatr., 15.","DOI":"10.1186\/s12877-015-0103-3"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e70260","DOI":"10.1111\/bcpt.70260","article-title":"Medication Burden: Beyond Counts to Recognize Polypharmacy as an Inherent Part of Living With Chronic Kidney Disease","volume":"139","author":"Houlind","year":"2026","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1053\/j.ajkd.2025.01.007","article-title":"Diagnosis and management of dementia for the nephrology clinician: A review","volume":"86","author":"Liu","year":"2025","journal-title":"Am. J. Kidney Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1053\/j.jrn.2024.06.001","article-title":"Cognitive Disorders in Chronic Kidney Disease: We Are What We Eat","volume":"34","author":"Garneata","year":"2024","journal-title":"J. Ren. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1212\/01.wnl.0000240224.38978.d8","article-title":"Associations of vegetable and fruit consumption with age-related cognitive change","volume":"67","author":"Morris","year":"2006","journal-title":"Neurology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3644","DOI":"10.1002\/alz.12982","article-title":"The association of MIND diet with cognitive resilience to neuropathologies","volume":"19","author":"Wagner","year":"2023","journal-title":"Alzheimers Dement."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2259","DOI":"10.1212\/WNL.0000000000207176","article-title":"Association of Mediterranean-DASH Intervention for Neurodegenerative Delay and Mediterranean diets with Alzheimer disease pathology","volume":"100","author":"Agarwal","year":"2023","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"639","DOI":"10.3945\/ajcn.115.110775","article-title":"Effects of vitamin B-12 supplementation on neurologic and cognitive function in older people: A randomized controlled trial","volume":"102","author":"Dangour","year":"2015","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e018573","DOI":"10.1136\/bmjopen-2017-018573","article-title":"The association between macronutrient intake and cognition in individuals aged under 65 in China: A cross-sectional study","volume":"8","author":"Ding","year":"2018","journal-title":"BMJ Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1038\/nrn3820","article-title":"Polyunsaturated fatty acids and their metabolites in brain function and disease","volume":"15","author":"Bazinet","year":"2014","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100136","DOI":"10.1016\/j.advnut.2023.10.008","article-title":"Roles of diet-associated gut microbial metabolites on brain health: Cell-to-cell interactions between gut bacteria and the central nervous system","volume":"15","author":"Kim","year":"2024","journal-title":"Adv. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1053\/j.jrn.2026.01.005","article-title":"Chronic Kidney Disease, Nutrition, and the Brain: How to Maintain Brain Health Through Nutrition in Chronic Kidney Disease","volume":"36","author":"Levassort","year":"2026","journal-title":"J. Ren. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Di Iorio, B.R., Rocchetti, M.T., De Angelis, M., Cosola, C., Marzocco, S., Di Micco, L., di Bari, I., Accetturo, M., Vacca, M., and Gobbetti, M. (2019). Nutritional Therapy Modulates Intestinal Microbiota and Reduces Serum Levels of Total and Free Indoxyl Sulfate and P-Cresyl Sulfate in Chronic Kidney Disease (Medika Study). J. Clin. Med., 8.","DOI":"10.3390\/jcm8091424"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2988","DOI":"10.1016\/j.ekir.2024.07.021","article-title":"Increased blood-brain barrier permeability and cognitive impairment in patients with ESKD","volume":"9","author":"Bobot","year":"2024","journal-title":"Kidney Int. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Liu, J., Wan, J., Chen, K., He, Y., Zhang, W., Luo, J., and Li, D. (2025). The relationship between protein-energy wasting and cognitive impairment in patients receiving maintenance hemodialysis. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1619083"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1056\/NEJMoa2302368","article-title":"Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons","volume":"389","author":"Barnes","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e70045","DOI":"10.1111\/eci.70045","article-title":"Nutrition, cognition and chronic kidney disease: A comprehensive review of interactions and interventions","volume":"55","author":"Kanbay","year":"2025","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1097\/TP.0000000000000968","article-title":"Cognitive Changes in Chronic Kidney Disease and After Transplantation","volume":"100","author":"Majoie","year":"2016","journal-title":"Transplantation"},{"key":"ref_50","first-page":"6","article-title":"Biostatistics, legislative and ethical problems of comparative clinical studies","volume":"66","author":"Mircioiu","year":"2018","journal-title":"Farmacia"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3035\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:03:06Z","timestamp":1789567386000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":50,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18183035"],"URL":"https:\/\/doi.org\/10.3390\/nu18183035","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}