Confusion is one of many possible renal failure symptoms. It may occur due to the way kidney disease develops, the mental health implications of the disease, and the side effects of treatments.

People may also refer to renal failure as kidney failure.

The kidneys’ role in the body is to filter waste and toxins from the blood and expel them in the urine. Kidney failure symptoms occur due to a buildup of toxins, waste, and excess water in the body.

This article explores the link between confusion and kidney failure, as well as how healthcare professionals may treat this confusion. The article also discusses other symptoms of kidney failure and treatment options.

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Cognitive issues, which may include confusion and memory loss, may be up to three times more common in people with severe kidney failure than in those without, according to a 2021 review.

There are several underlying links between the kidneys’ function and the brain that could factor into kidney failure’s cognitive symptoms.

Uremic encephalopathy

Uremic encephalopathy is a change in brain function that occurs due to the buildup of toxins in the body as a result of kidney failure. It may occur due to the following factors:

  • changes in how the body processes hormones
  • an imbalance of electrolytes, such as salt and potassium, in the body
  • imbalanced acid levels
  • toxins transporting from the blood to the brain
  • changes in how the blood vessels work, including those in the brain
  • inflammation

There are no imaging tests to confirm a uremic encephalopathy diagnosis. Instead, doctors diagnose the condition after recovery if dialysis relieves the symptoms, which may include confusion.

Uremic encephalopathy presents in several ways, including:

Other factors can also cause confusion in people with renal failure and exacerbate it.

Vascular disease

According to a 2019 study, people with chronic kidney disease may have a higher risk of complications of blood vessels around the heart and brain, including:

Researchers hypothesize that confusion due to kidney failure mostly seems to affect processing and executive functions. These factors influence a person’s ability to plan and perform tasks. Cerebrovascular diseases, such as stroke, can also impair these cognitive abilities.

This implies a possible link between vascular damage and cognitive issues in kidney failure, although more evidence is necessary.

Depression and anxiety

Another 2021 study estimated that up to half of all people with kidney failure who receive dialysis treatment experience depression and anxiety symptoms. This may be due to the regular commitment involved in dialysis.

According to the National Kidney Foundation, in-hospital dialysis takes 3–3.5 hours three times a week. Home dialysis options are available, but these also require a daily session of 1.5–2 hours. This causes significant lifestyle changes.

Depression and anxiety can lead to cognitive issues, such as confusion, lethargy, and memory issues.

Dialysis-related issues

Hemodialysis is a type of dialysis treatment that involves removing blood from the body, cleaning it, and infusing it back to the individual. This can lead to rapidly changing fluid levels, which may cause significant swings in blood pressure. Low blood pressure, in particular, can slow blood flow to the brain.

A 2017 study of 635 hemodialysis sessions found that low blood pressure directly led to brain damage due to reduced blood flow in the brain in around 24% of the sessions. In roughly 32% of the sessions that caused this damage, people experienced cognitive symptoms within 12 months.

Taking too many medications for kidney failure

People with kidney failure may take several medications. In some cases, these medications may interact with each other.

Additionally, the kidneys may have difficulty clearing the medications from the body as they usually would. This could increase the risk of a sedative effect, as well as delirium and confusion.

Learn more about drug interactions.

Dialysis is a process that involves a machine filtering the blood before returning it to the individual with kidney failure. Research included in a review from 2021 suggests that in many people who experience uremic encephalopathy, which may cause confusion due to kidney failure, symptoms resolve once dialysis helps to remove toxins from the blood.

However, other options for managing confusion as a result of kidney failure may include:

  • preventing extreme changes in blood pressure during dialysis with techniques such as cooling the blood, which a 2016 meta-analysis found reduced the risk of low blood pressure during hemodialysis by 70%
  • undergoing a kidney transplantation, which is an alternative to dialysis that may help people who experience extreme blood pressure changes after sessions
  • taking steps to manage mental health conditions, such as depression
  • improving sleep hygiene, as people receiving hemodialysis may experience sleep disturbances

Renal failure causes other symptoms, including:

There are three main treatments for kidney failure, two of which involve dialysis:

  • Hemodialysis: A machine outside the body filters the blood.
  • Peritoneal dialysis: The stomach lining helps filter the blood inside the body.
  • Kidney transplant: This involves surgically transporting a working kidney from a donor into a person with renal failure.

Each treatment has advantages and disadvantages, but all require significant daily adjustments.

Therefore, some people choose not to receive life-extending dialysis or transplantation treatment. Instead, they work with healthcare professionals to manage symptoms and preserve their kidney function for as long as possible. Palliative care may help a person manage any emotional and physical difficulties they are experiencing.

Learn more about treatments for kidney failure.

Research suggests that kidney failure may cause cognitive impairments, which may involve confusion as a result of fluid imbalances, blood vessel damage in the brain, depression and anxiety, and the side effects of medications and dialysis treatment.

Confusion due to kidney failure may improve following dialysis or kidney transplantation. Managing mental health conditions and improving sleep hygiene may also help.

A person should speak with a doctor if they are experiencing any symptoms of kidney failure. Additionally, if they have received a kidney failure diagnosis, they should inform a healthcare professional if their symptoms change or worsen. A doctor can also advise someone about which treatments may work best for them.