Table 2:

A proposed multi-item approach for detecting and managing cognitive impairment in CKD patients.

Item	Action
Routine cognitive screening	Regular cognitive assessments using sensitive tools like the MMSE questionnaire and/or the MoCA to be integrated into the clinical care of CKD patients. Screening should consider the timing related to dialysis sessions for HD patients to ensure accurate results.
Comprehensive assessment	A thorough evaluation, including medical history, laboratory tests and imaging studies, to identify reversible causes of cognitive impairment and tailor interventions accordingly. Computed tomography and magnetic resonance imaging are particularly encouraged in suspected secondary cognitive impairment.
Tailored cognitive rehabilitation	Implement cognitive rehabilitation programs focusing on attention and executive functions to be overseen by neuropsychologists or trained healthcare providers and adapted to address specific deficits in CKD patients.
Physical exercise and nutritional optimization	Encourage regular physical exercise and a balanced diet to support cognitive function. Nutritional interventions should aim to manage gut dysbiosis and reduce inflammation, which can impact cognitive health.
Medication management	Carefully manage medications to avoid drugs or drug combinations with potential negative effects on cognition. Optimize the use of drugs for cardiovascular and cerebrovascular protection, blood pressure control and proteinuria lowering where appropriate. SGLT2is, given their emerging evidence of cognitive benefit, should be considered.