Mikail DAĞ, Edip ERKUŞ, Fatih SAÇKAN, İlhan YAPICI, İbrahim GÜNEY, Muhammet Cemal KIZILARSLANOĞLU
The Journal of European Internal Medicine Professionals - 2026;4(3):73-80
Background: Older adults with chronic kidney disease are highly vulnerable to polypharmacy. This study aimed to investigate the multidimensional impact of cumulative anticholinergic burden on physical functionality, health-related quality of life, and cognitive performance in this specific population. Methods: In this cross-sectional study, 234 patients with chronic kidney disease were evaluated. The anticholinergic burden was calculated using the updated Anticholinergic Cognitive Burden scale. Physical independence, cognitive status, and health-related quality of life were assessed using the Katz Index of Independence in Activities of Daily Living, the Mini-Cog test, and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire, respectively. Multiple regression models were utilized to adjust for confounders, including age and overall comorbidity burden. Results: Patients in the high Anticholinergic Cognitive Burden group were significantly older and more likely to be female. The most frequent contributors to the anticholinergic burden were cardiovascular medications, primarily beta-blockers and loop diuretics. In multiple regression analysis, a high anticholinergic burden emerged as a strong, independent predictor of decreased physical independence (Katz Index) and diminished health-related quality of life (EQ-5D-5L) (p < 0.05). Conversely, the initial negative correlation between Anticholinergic Cognitive Burden scores and cognitive performance (Mini-Cog scores) lost its statistical significance after adjusting for age and comorbidity. Conclusion: Anticholinergic burden may independently impair physical functionality and health-related quality of life in older chronic kidney disease patients, whereas its cognitive impact is heavily mediated by age and comorbidities. Routine medication reviews that prioritize evaluating alternative agents with lower anticholinergic properties and closer clinical monitoring should become a standard component of chronic kidney disease management.
