Tips for driving with kidney or liver disease

Chronic renal failure affect cellular function and metabolism

Kidney failure

Elevated levels of urea can cause discomfort, anorexia, laxity, fatigue, vomiting, decreased mental acuity, shortness of breath, nausea and convulsions.

Chronic kidney failure alters cell function and metabolism, as well as the volume and composition of body fluids, presenting as polyuria and nocturia in the mild to moderate stages of renal failure.

Neurological alterations are frequent, with tingling and prickling (paresthesia) due to distal, bilateral and symmetrical polyneuropathy, nocturnal burning sensation, restless legs and muscle cramps.

Signs of encephalopathy can include confusion, hypervigilance disorders, seizures and abnormal movements with shaking tremor or myoclonus (involuntary, brief, jerky, sudden, twitching movement).

Psychological disorders such as depression or irritability develop.

In advanced cases, uremic encephalopathy sets in, with asterixis (flapping tremor), convulsions and coma.

Dialysis, which relieves renal failure, can produce dementia and “imbalance” and, on the other hand, symptoms from simple nausea to seizures.
Various medications, particularly antibiotics, can trigger signs of severe encephalopathy with seizures in these patients.

Advice for driving

Patients with mildly decreased renal reserves do not present symptoms, so they are able to drive.
Mild to moderate renal failure may cause only mild symptoms such as nocturia, which does not interfere with driving, except for the fatigue caused by the lack of adequate rest at night.
The first manifestations of uremia such as laxity, fatigue and decreased mental acuity reduce driving ability, so driving is not recommended until the specialist, after administering the appropriate treatment and following the subsequent favorable evolution of the patient, decides that the individual can drive safely.
Neuromuscular symptoms such as abrupt muscle contractions, peripheral neuropathies with sensory and motor issues, muscle spasms and seizures impede driving.
Sufferers should not drive when there are episodes of ulceration with gastrointestinal bleeding and the risk of bleeding, which occur in advanced disease.
Patients with stable chronic renal failure with few symptoms may decompensate acutely in the presence of an intercurrent disease and deteriorate abruptly. Patients should not drive until they are stabilized and symptom-free.
Patients with diabetic nephropathy who do not adjust their insulin doses to the progression of their renal failure can suffer severe episodes of hypoglycemia. If this occurs while driving, it could lead to them losing control of the vehicle.
Patients who drive with renal insufficiency should be aware that many drugs can produce side effects that will interfere with driving if the dose is not adjusted. This is the case with anxiolytic drugs, antidepressants, anticonvulsants, and so on, and the patient should be aware of their adverse effects.
Driving is not recommended for drivers suffering from uncontrolled psychological and depressive disorders until their doctor has verified a favorable evolution of their mental state.
Hemodialysis sessions make driving impossible due to the potential and frequent side effects that patients experience at the end of a session.
Driving safety in the days in between dialysis sessions depends on the symptoms that the patient exhibits, both those of renal failure and those of the underlying disease.
In general, these patients are vulnerable due to advanced renal failure, so it is recommended that they take the fewest possible risks, one of the most important of which is driving.

Hepatic encephalopathy

This is relatively frequent in certain liver diseases such as cirrhosis.

Encephalopathy in cirrhosis often has a triggering factor such as gastrointestinal bleeding or certain drugs, like barbiturates, morphine, benzodiazepines, and acetazolamide, among others.

Hepatic encephalopathy is characterized by central nervous system disorders, with decreased consciousness ranging from drowsiness and confusion to stupor and coma.

Sleep rhythm inversion, intellectual disturbances with bradypsychia, attention deficit and temporo-spatial disorientation are frequent, as are personality disturbances with euphoria, depression, aggressiveness and behavioral disturbances.

Neuromuscular disturbances often present with asterixis, hypertonia, seizures, tremor, ataxia, amimia, choreoathetosis, spastic paraplegia, hallucinations, slurred speech, and so on.

Treating these patients is complex and multidisciplinary and requires expert physicians in order to avoid complications.

Liver transplants have given many of these patients their lives back.

Advice for driving

Patients with mild or moderate liver failure, whose only symptom is dyspepsia, may drive.

If the underlying disease is chronic and progressive, at some point in the course of the patient’s illness, they will begin to experience neurological alterations, a loss of attention and drowsiness, which will make them unfit to drive.

Their doctor must advise them not to drive when the clinical symptoms make it unsafe, and they should notify the patient of this in writing.

Liver transplants give these patients back their lives and make it possible for a large number to drive again once their doctor deems it appropriate, again after issuing a written report.

Uremic encephalopathy

Uremic encephalopathy is a complication that appears in patients with advanced renal failure as a consequence of toxins accumulating in their bodies. It is characterized by a series of neurological symptoms, including mental confusion, drowsiness, tremors, myoclonus (involuntary, sudden, jerky movements) and asterixis. In severe cases, it can lead to convulsions, coma and even death. In addition, patients may experience psychological disorders, such as depression and irritability, which worsen their quality of life.

Advice for driving

Driving should be discouraged in patients suffering from uremic encephalopathy or at risk of it. The main reasons they should not drive include:

Mental confusion and drowsiness, which impair a person’s focus and ability to react.
The appearance of tremors or convulsions, which make it impossible to keep control of the vehicle.
The side effects of dialysis can produce fatigue, dizziness and disorientation, especially after each session.
The doctor should adjust the patient’s medication and perform periodic check-ups to ensure that they are fit to drive safely. If the symptoms worsen, the patient should not drive until they have stabilized.

Renal encephalopathy

Renal encephalopathy is a neurological complication of advanced renal failure. This disorder occurs as a result of the accumulation of toxins in the body, which directly affects the central nervous system. Symptoms include confusion, vigilance disorders, drowsiness and, in more advanced stages, myoclonus, tremors and seizures. Severe cases may trigger coma. In addition, it is common for patients to present psychological conditions, such as depression and irritability, which can aggravate their general condition and compromise their ability to perform daily activities, such as driving.

Advice for driving

It is not advisable for patients with symptoms of renal encephalopathy to drive because of the following risks:

Confusion and drowsiness reduce alertness and reaction capacity, compromising road safety.
Myoclonus and tremors make it difficult to control the vehicle properly, increasing the risk of accidents.
Following hemodialysis sessions, driving should be avoided, as patients may experience side effects including fatigue and disorientation, which limit their ability to drive safely.
Medication must be adjusted carefully, since the side effects of the drugs used to treat renal failure, such as anticonvulsants and antidepressants, can interfere with driving.
If patients present a sudden deterioration in their clinical condition, such as seizures or worse neurological symptoms, they should not drive until their symptoms are under control.