Does kidney failure cause hallucinations, forgetfulness?

by D
(CA)




Quick Answer
Yes. Advanced kidney failure can cause poor concentration, forgetfulness, unusual sleepiness, confusion and, less commonly, hallucinations. One possible cause is uremic encephalopathy, in which severe kidney dysfunction allows retained wastes and chemical imbalances to affect the brain. However, new hallucinations or sudden confusion are medical emergencies because infection, medication accumulation, low or very high blood sugar, stroke and other treatable conditions may cause the same symptoms.


Answer by Dr. Albana Greca, MD, MMedSc



Hello,



Yes, severe kidney failure can affect memory, attention and behavior. However, hallucinations are not an inevitable or normal part of kidney disease. A person who suddenly becomes confused, sees or hears things that are not present, or is difficult to wake should be assessed urgently.



Why Can Kidney Failure Affect the Brain?



Healthy kidneys remove waste and extra fluid and help regulate sodium, potassium, calcium and the body's acid-base balance. When kidney function becomes severely reduced, several metabolic problems may affect brain function.



This is called uremic encephalopathy. It is not caused by one toxin simply “reaching the brain.” It likely involves retained uremic substances, chemical imbalances and inflammation.



Possible symptoms include:




  • poor concentration or slowed thinking;

  • short-term memory problems and forgetfulness;

  • unusual sleepiness, restlessness or altered sleep;

  • confusion, disorientation or unusual behavior;

  • tremor, jerking, seizures or coma in severe cases.



Learn more about diabetes and kidney disease.




Important correction: Chronic kidney failure is usually irreversible, but uremic confusion may improve with dialysis or transplantation. Acute kidney injury may recover when its cause is treated.


Hallucinations May Have Another Cause



New hallucinations often occur as part of delirium, which is a sudden disturbance of attention and awareness. In someone with kidney disease, possible causes include:




  • infection: pneumonia, urinary infection, bloodstream infection or an infected dialysis access;

  • medicine accumulation: reduced kidney clearance can increase the effects of sedatives, opioid pain medicines and other drugs;

  • electrolyte or acid-base abnormalities;

  • low or very high blood sugar;

  • stroke, seizure, low oxygen or very high blood pressure;

  • missed or inadequate dialysis;

  • dehydration, bleeding or sudden worsening of kidney function.



Diabetes can also cause mental changes when glucose is very low or high, so check it if this will not delay urgent care. See mental changes in diabetes.




Seek emergency care now for new hallucinations, sudden confusion, inability to recognize familiar people, severe drowsiness, seizure, fainting, one-sided weakness, trouble speaking, severe headache, chest pain, breathing difficulty, fever or inability to wake the person normally. Do not leave the person alone.


What Should Be Done Immediately?




  • Call emergency services when symptoms are sudden, severe or worsening.

  • Check glucose if the person has diabetes and testing will not delay care.

  • Do not give food, drink or tablets by mouth if the person is not fully alert or cannot swallow safely.

  • Do not give alcohol, sleeping tablets or additional pain medicine.

  • Bring the complete medication list, recent laboratory results and dialysis schedule.

  • Report missed dialysis and any access redness, drainage or loss of vibration.



What Will the Medical Team Check?



The evaluation may include a neurological and mental-status examination, medication review and tests for:




  • urea, creatinine and the current level of kidney function;

  • sodium, potassium, calcium, magnesium, bicarbonate and glucose;

  • infection, anemia and oxygen level;

  • blood pressure and fluid overload;

  • stroke, bleeding or seizure when the symptoms suggest them;

  • dialysis adequacy and vascular-access function.



There is no single laboratory value that proves uremic encephalopathy. Doctors use the clinical picture, exclusion of other causes and response to kidney-replacement treatment.



Can Treatment Improve the Symptoms?



Yes, depending on the cause. Hemodialysis filters wastes and extra water from the blood and helps correct mineral imbalances. Uremic encephalopathy is an important reason to begin or intensify kidney-replacement therapy, and mental function may improve.



Dialysis does not cure chronic kidney failure and does not guarantee that every memory problem will disappear. Recovery depends on severity, duration and whether another brain disorder is present.



What About Gradual Forgetfulness?



Slowly developing forgetfulness also deserves medical review. Kidney disease may contribute, but anemia, poor sleep, depression, thyroid disease, vitamin deficiency, medication effects, vascular disease and dementia may coexist.



Record when changes began, whether they fluctuate, medicine changes, missed dialysis, glucose, fever and any falls. A family member or caregiver should attend the appointment when possible.



My Advice



Yes, advanced kidney failure can cause confusion, forgetfulness and occasionally hallucinations, but these symptoms should never be accepted as an unavoidable final stage. Sudden hallucinations or rapidly changing awareness require emergency assessment.



If the symptoms are gradual, contact the kidney specialist promptly to review kidney function, dialysis adequacy, medicines, glucose, electrolytes, infection and other neurological causes.



Hope this helps.



Dr. Albana Greca



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References






Educational only — not personal medical advice. New hallucinations, sudden confusion, severe drowsiness, seizure or inability to wake a person with kidney disease requires emergency medical care.


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