This article is more than 5 years old. Information may no longer be current.
Cognitive function declines in frail patients 1 year to 4 years after kidney transplant
Although both frail and non-frail patients experienced cognitive improvement 3 months following kidney transplant, cognitive function remained stable for non-frail patients and declined among frail patients at 1 year to 4 years post-transplant, according to a study published in the Journal of the American Society of Nephrology.
“The good news is that, on average, patients appeared to experience improvements in cognitive functioning within the first year of follow-up post-transplantation, regardless of their age, sex, race, or frailty status,” Nadia Chu, PhD, MPH, instructor of surgery and epidemiology at the Johns Hopkins School of Medicine with a joint appointment at the Johns Hopkins Bloomberg School of Public Heath, told Healio Nephrology. “However, beyond that first year of follow-up, we found that while most patients remained relatively stable over time, some patients--namely those patients who were frail at the time of transplantation--began to deteriorate in cognitive functioning steadily over the 4-year follow-up, reaching cognitive levels that were on average below their pre-transplant levels."
To map post-transplant cognitive trajectories among frail and non-frail patients, researchers conducted a longitudinal two-center cohort study of 665 kidney transplant recipients aged 18 years or older. Pre-transplant frailty was determined using the Fried physical frailty phenotype and patients were subsequently categorized as being frail (n = 100; mean age, 55 years; 44% women; mean years on dialysis, 3) or non-frail (n = 565; mean age, 51.4 years; 37.9% women; mean years on dialysis, 2.6).
Using the modified mini-mental state exam, researchers measured cognitive function in participants at 1 month, 3 months, 6 months, 12 months, and then up to 4 years post-transplant. Follow-up was for a median of 1.5 years.
After adjusting for recipient, donor and transplant factors, researchers found pre-transplant cognitive scores were lower among frail patients than non-frail patients (89 vs. 90.8) but that by 3 months, cognitive performance improved for both frail (slope = 0.22 points/week) and non-frail (slope = 0.14 points/week) patients.
However, between 1 year and 4 years post-transplant, researchers observed that improvements plateaued among non-frail patients (slope = 0.005 points/week) and cognitive function declined among frail patients (slope = 0.04 points/week).
At 4 years, cognitive scores were 5.8 points lower for frail patients than non-frail patients.
“Clinicians should consider assessing global cognitive function prior to transplantation and continue to monitor it at follow-up visits, particularly among frail recipients,” Chu said. “As interventions to preserve and/or improve cognitive function are identified, clinicians should begin implementing them among frail candidates and recipients. Further research is needed to better understand the underlying mechanisms driving the decline in cognition among frail kidney transplant recipients so that we can develop effective interventions that can prevent deterioration and improve outcomes and quality of life post-transplantation." – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.