2026 ECNP Congress

PS03-3233

Association between psychotic decompensation and serum urea, creatinine, and uric acid levels in patients with chronic kidney disease

Nikola Stojanovic — G. Nikolic, M. Petkovic, J. Brankovic · Centre for mental health protection- University Clinical Centre Niš- Serbia, Department of addictology, Nis, Serbia

2026 ECNP Congress

Introduction

Chronic kidney disease (CKD) is a progressive disorder characterized by sustained impairment of renal function and accumulation of metabolic waste products, including urea, creatinine, and uric acid. Beyond its systemic consequences, CKD is increasingly recognized as a condition associated with neuropsychiatric manifestations, ranging from cognitive impairment and mood disturbances to, in some cases, psychotic symptoms [1]. Uremic encephalopathy represents a spectrum of central nervous system abnormalities arising in the context of impaired kidney function. Its pathophysiology is multifactorial and involves the accumulation of uremic toxins, metabolic and electrolyte disturbances, oxidative stress, neuroinflammation, and alterations in blood–brain barrier function. The absence of specific diagnostic markers, along with overlap with other clinical conditions, complicates its recognition, and diagnosis is often made retrospectively following improvement after dialysis or transplantation [2]. The mechanisms linking CKD to psychiatric disturbances, particularly psychotic symptomatology, remain incompletely understood. Elevated levels of urea, creatinine, and uric acid may contribute to central nervous system dysfunction either directly through neurotoxic effects or indirectly via systemic metabolic imbalance, vascular injury, and inflammation. Although these biochemical parameters are routinely monitored in CKD patients, their relationship with psychotic symptom changes remains insufficiently defined [3], while early reports suggest a potential role of urea in psychotic manifestations [4]. Therefore, this study aimed to investigate the association between psychotic symptomatology and serum levels of urea, creatinine, and uric acid in patients with CKD.

Methods

A retrospective analysis (from June 2023 to June 2025) of medical records at the Clinic for Nephrology was obtained from the electronic patient monitoring system of the University Clinical Centre Niš. Patients evaluated by psychiatrists during consultation were included, and the occurrence of psychotic decompensation was recorded, together with serum levels of urea, creatinine, and uric acid on the day of examination. Based on suggested toxic values for these parameters [5], patients with psychotic decompensation were categorized according to whether the episode could be associated with altered serum levels.

Results

Out of 254 patients examined by a psychiatrist at the Clinic for Nephrology, 62 (24%) developed psychotic decompensation. Urea values higher than 38 ±18 mmol/L were found in 36 (58%) patients, creatinine values higher than 1202 ± 407 µmol/L were found in 12 (19%) patients, while uric acid values higher than 496 ± 265 µmol/L were found in 51 (82%) patients. Interestingly, when examining patients with psychotic decompensation in relation to all three parameters exceeding suggested cut-off values, only 7 (11%) met this criterion.

Conclusions

These findings suggest that elevated uric acid levels are most frequently associated with psychotic decompensation in CKD patients, whereas simultaneous elevation of all three parameters is relatively uncommon. This indicates that factors beyond standard metabolic markers likely contribute to psychiatric deterioration in CKD. These may include vascular pathology, brain injury related to microvascular changes, and inflammatory processes, as well as other biologically active molecules. Further research is required to better define these interactions and their clinical significance.

References

  1. Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G, Massy ZA. Cognitive disorders and dementia in CKD: the neglected kidney-brain axis. J Am Soc Nephrol. 2013;24(3):353-63.
  2. Rosner MH, Husain-Syed F, Reis T, Ronco C, Vanholder R. Uremic encephalopathy. Kidney Int. 2022;101(2):227-241.
  3. Simões E Silva AC, Miranda AS, Rocha NP, Teixeira AL. Neuropsychiatric Disorders in Chronic Kidney Disease. Front Pharmacol. 2019;10:932.
  4. Baker AB, Knutson J. Psychiatric aspects of uremia. Am J Psychiatry. 1946;102:683-7.
  5. Vanholder R, De Smet R, Glorieux G, Argilés A, Baurmeister U, Brunet P, Clark W, Cohen G, De Deyn PP, Deppisch R, Descamps-Latscha B, Henle T, Jörres A, Lemke HD, Massy ZA, Passlick-Deetjen J, Rodriguez M, Stegmayr B, Stenvinkel P, Tetta C, Wanner C, Zidek W; European Uremic Toxin Work Group (EUTox). Review on uremic toxins: classification, concentration, and interindividual variability. Kidney Int. 2003;63(5):1934-43.