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Cognitive impairment is an under-recognised but clinically significant complication of chronic kidney disease (CKD). The global prevalence of CKD is approximately 10%, and it frequently affects neurological function, and particularly executive and language domains. This article encourages neurologists and neuropsychiatrists to consider CKD as a potential contributor to cognitive decline. By recognising the characteristic cognitive profile associated with CKD, and distinguishing it from coexisting neurodegenerative pathology, clinicians can implement early interventions that improve outcomes. We outline mechanisms that link CKD to cognitive dysfunction, present diagnostic approaches and offer multidisciplinary strategies for assessment and management.