doi: 10.1093/ndt/gft403 In Focus The reversible part of cognitive impairment in chronic kidney

Discussing the non-adherence to diet or medication with chronic haemodialysis patients can be an utterly frustrating experience, especially if one does this thrice a week. It is also a reflection of the fact that for more than half a century, nephrolo-gists have been focusing on cardiovascular morbidity and mor-tality in chronic kidney disease (CKD) patients. Over the last decade, however, burgeoning evidence has accumulated to show that CKD also affects the patient’s brain. CKD is accompanied by severe cognitive impairment as recently reviewed by Elias et al. [1]. Kurella et al. [2] could show that decreased estimated glomerular filtration rate (GFR) in postmenopausal women is significantly associated with impairment in global cognition, ex-ecutive function, language and memory. A community-based cross-sectional study found that global performance and specific cognitive functions are negatively affected early in CKD [3]. Interestingly, not only decreases in GFR but also elevated urinary albumin/creatinine ratios are independently associated with faster decline in cognitive function [4]. In a 5-year longi-tudinal community-based study, change in renal functioning over time was related to change observed in global cognitive ability, verbal episodic memory and abstract reasoning [5]. Moreover, moderate renal impairment has been shown to be associated with an excess risk of incident dementia among indi-viduals in good to excellent health [6]. Naturally, cognitive im-pairment cannot be revealed during the discussions about phosphate binders and anti-hypertensives. The backbone for detection of cognitive impairment are psychometric tests, first introduced in 1944 by the US Army in the Army Individua