Delirium after kidney transplantation increases risk of dementia, cognitive decline
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Patients who experience delirium after a kidney transplantation are at an increased risk for dementia and cognitive decline, according to data published in the American Journal of Transplantation.
“While there have been studies of the cognitive sequelae of delirium in other surgical populations, kidney transplantation (KT) is a unique surgery in which the restoration of kidney function improves cognition on average,” Mara A. McAdams-DeMarco, PhD, an associate professor of surgery and population health at New York University Grossman School of Medicine, told Healio. “In this study, we hoped to better understand how an episode of delirium during the KT hospitalization impacted post-KT cognitive performance and dementia risk.”
In a prospective cohort study of 894 KT recipients, researchers evaluated delirium, global cognitive function and executive function between 2009 and 2021. Patients were followed for a median of 1.8 years.
Researchers measured cognitive performance at the time of transplant, at 1 month, 3 months, 6 months, 1 year and annually after the transplant using mixed models. Additionally, they quantified dementia risk by delirium after KT using Fine and Gray competing risk.
Delirium after KT was determined using chart information, global cognitive function was identified using the modified mini-mental state exam and dementia diagnoses were collected from Medicare claims and the United States Renal Data System.
Overall, 4.8% of patients had delirium after KT and were more likely to be frail, have impairment in lower extremity function and be dependent in activities of daily living and instrumental activities of daily living at KT admission.
Researchers observed no correlation between delirium and global cognitive function at KT or trajectories after KT. However, delirium was associated with declining executive function more than 2 years after KT.
“The accumulating evidence from older surgical patients and our study of kidney transplant patients of all ages suggest that delirium is often a precursor of dementia,” McAdams-DeMarco said. “Transplant centers that observe patients with delirium during their transplant hospitalization should recognize that these patients are now at elevated risk of cognitive decline and at a 7.8-fold increased risk of being diagnosed with dementia.”
Limitations of the study include cognitive assessment tools with varying sensitivities and specificities for finding those with lower cognitive performance.
“We believe that post-transplant cognitive aging is an important and emerging field. Nadia Mikhail Chu, PhD, MPH, the first author, and I are committed to furthering research in this field,” McAdams-DeMarco concluded. “Delirium is a key risk factor for adverse long-term cognitive aging, and we hope to better understand who is at risk for delirium, how we can prevent it and how we can treat post-KT delirium.”
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