CKD, nutrition and the brain: How to maintain brain health through nutrition in CKD.

Chronic kidney disease (CKD) is increasingly recognized not only as a kidney disorder but also as a contributor to cognitive impairment. The kidney and brain share a common vulnerability to uremic toxins (UTs), whose accumulation in CKD is exacerbated by gut dysbiosis. These toxins impair the integrity of the blood-brain barrier (BBB), reduce neurogenesis, and promote neuroinflammation. Therefore, maintaining brain health in CKD requires a holistic approach targeting the gut-kidney-brain axis. Nutritional strategies, particularly plant-based diets such as the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets, have demonstrated benefits for both renal and cerebral outcomes. Because dietary interventions alone may be insufficient, combining nutritional approaches with physical activity and pharmacological strategies, such as Glucagon-Like Peptide-1 (GLP-1) receptor agonists or Sodium Glucose Co-Transporters 2 (SGLT2) inhibitors, may offer synergistic effects. Understanding and modulating the interactions between diet, microbiota, and UTs is essential to preserve cognitive and kidney function in CKD patients, highlighting the need for integrated care.