Cognitive function before kidney transplant does not affect clinical outcomes
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Key takeaways:
- Worse pretransplant cognitive function scores did not predict clinical outcomes.
- Better scores were statistically, but not clinically, significantly associated with greater decline in eGFR.
Adults with lower cognitive scores before kidney transplantation had similar kidney function, hospital length of stay and readmission and death rates as those with higher pre-transplant scores, according to study data.
“Kidney transplant recipients undergo a thorough evaluation process before being listed for kidney transplant. Cognitive function, however, is not routinely assessed,” Aditi Gupta, MD, MS, professor and director of clinical trials in the division of nephrology and hypertension in the departments of internal medicine and neurology at the University of Kansas Medical Center, and colleagues wrote in their study background. “Both cognitive function and post-kidney transplant outcomes can be affected by comorbid conditions, such as diabetes, hypertension, dyslipidemia, obesity, metabolic syndrome and physical inactivity. It is thus important to determine whether pretransplant cognitive function affects posttransplant outcomes independent of these confounding variables.”
Worse pretransplant cognitive function scores did not predict clinical outcomes. Image: Adobe Stock.
In a prospective cohort study, Gupta and colleagues analyzed data from 501 consecutive adults (mean age, 53 years; 58% male; 73% white) who were evaluated for kidney transplantation at their institution from Feb. 13, 2015, to Dec. 18, 2019, and received a transplant before May 2022. During evaluation, all participants completed the Montreal Cognitive Assessment (MoCA) to assess cognitive function, with higher scores indicating better cognitive function. Data were collected from medical records and the United Network for Organ Sharing for a mean follow-up of 2.7 years.
Among the cohort, pretransplant MoCA scores ranged from 12 to 30 — the highest score possible — with a mean score of 25 and 52% of scores less than 26.
Higher MoCA scores were statistically, but not clinically, significantly associated with greater decline in eGFR (beta = 0.28; 95% CI, –0.55 to –0.01), according to researchers.
MoCA scores were not significantly associated with length of transplantation hospital stay, readmission at 30 days or 90 days, organ rejection at 90 days or 1 year, organ loss or death. Researchers observed some variables associated with clinical outcomes — for example, recipients from living donors had better posttransplant kidney function; older patients had longer hospital stays and higher readmittance and mortality rates; patients with diabetes had a higher mortality rate — but none of the relationships had interactions with MoCA.
“Cognitive impairment in CKD is potentially reversible and improves with kidney transplant. Thus, metabolic and uremic factors that improve after kidney transplant may be contributing [to cognitive impairment],” Gupta told Healio. “Cognitive function alone should not be used to declare someone ineligible for kidney transplant. Kidney transplant, in fact, should be treated as a treatment for cognitive impairment. In patients with CKD, physicians should be aware of the high burden of cognitive impairment. This means that they might need to repeat instructions, use written instructions or even use visuals to educate their patients.”
For more information:
Aditi Gupta, MD, MS, can be reached at agupta@kumc.edu.
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