ArticleJournal of the American Geriatrics Society2025
The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment.
Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Review
- Medication Burden: Beyond Counts to Recognize Polypharmacy as an Inherent Part of Living With Chronic Kidney Disease.Basic & clinical pharmacology & toxicology · 2026Article
- Anticholinergic Burden and Progression to Kidney Replacement Therapy.Kidney international reports · 2026Article
- Hyperpolypharmacy in patients with chronic kidney disease and its impact on clinical outcomes.Scientific reports · 2026Article
- Cholinergic system in patients with chronic kidney disease: cognitive and renal implications.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025Review
- Anticholinergic medicines - medication management, prescribing cascades, and deprescribing.International journal of clinical pharmacy · 2025Article
- The anticholinergic burden in patients with chronic kidney disease: Patterns, risk factors, and the link with cognitive impairment.Journal of the American Geriatrics Society · 2025Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundPeople with chronic kidney disease (CKD) have an elevated risk of cognitive impairment (CI). Medications with anticholinergic activity are recognized for their adverse reactions on central nervous system. The putative association between the anticholinergic burden and CI has not previously been evaluated in patients with CKD. The study aimed to (i) describe prescriptions of medications with anticholinergic activity, (ii) analyze factors associated with these prescriptions, and (iii) evaluate the anticholinergic burden's association with cognitive performance.
methodsCKD-REIN, a prospective cohort study, enrolled nephrology outpatients with a confirmed diagnosis of CKD (eGFR <60 mL/min/1.73m
resultsAt baseline, 3007 patients (median age [IQR], 69[60-76]; 65% men) had MMSE data and were included. 1549 (52%) of these patients were taking at least one drug with anticholinergic properties. Most (1092; 70%) had a low anticholinergic burden, 294 (19%) had a moderate anticholinergic burden, and 163 (11%) had a high anticholinergic burden. A history of neurological/psychiatric disorders and a higher number of daily drugs were associated with a greater probability of having a high anticholinergic burden (odds ratio (OR) [95% confidence interval (95% CI)] = 1.88[1.29;2.74] and 1.53[1.45;1.61], respectively). Patients with a high anticholinergic burden had a significantly higher probability of presenting cognitive impairment, compared with patients without an anticholinergic burden (OR[95% CI] = 1.76[1.12;2.75]) after adjustment for sociodemographic factors, comorbidities, laboratory data, and the number of medications taken daily.
conclusionsThe results of our study emphasize the need for caution in the prescription of drugs with anticholinergic properties to patients with CKD.
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