Impact of Cognitive Function Change on Mortality in Renal Transplant and End-Stage Renal Disease Patients

Abstract

Background: Limited evidence from small-scale studies, mainly involving end-stage renal disease (ESRD) patients, suggests that kidney transplantation may improve cognitive function. We examined changes in cognitive function after a kidney transplant and its association with survival in advanced chronic kidney disease (CKD)/ESRD patients. Methods: In a prospective study design, cognitive performance of 90 patients (50.6 ± 13.1 years, 66.7% men, 27.8% blacks, 76% CKD stages 4-5) was assessed at the respective patients' residences using established neurocognitive tests. Results: Among the 90 patients, 44 received a kidney transplant (KTx group) while 46 did not (no-KTx group). After a mean follow-up of ∼19 months, there was no significant change in scores for majority of cognitive tests in either group. Older age, but not diabetes or renal function status (CKD vs. ESRD), was a determinant of poor follow-up cognitive performance. Additionally, poor attention/psychomotor speed and executive performance (as measured by Trails A and Stroop test, respectively) was associated with higher mortality over a mean follow-up of 4.7 years, even after adjustment for age, sex, diabetes, CKD or ESRD status and kidney transplant status. Conclusion: Overall, cognitive function does not significantly improve after kidney transplant or significantly decline in non-transplanted, advanced CKD/ESRD patients. Poor attention, psychomotor speed and executive performance independent of transplant status were associated with higher mortality over time.

A Systematic Review of Cognitive Impairments Associated With Kidney Failure in Adults Before Natural Age-Related Changes

“…This is largely due to the wide use of the Mini-Mental State Examination (MMSE) in this group (Folstein, Folstein, & McHugh, 1975), which only provides a measure of general cognition. These deficits compound normal cognitive aging (Buchman et al, 2009), are exacerbated with CKD progression (Romijn et al, 2015) and are related to an increased risk for mortality (Sharma et al, 2016) and comorbid conditions such as dementia (Bugnicourt, Godefroy, Chillon, Choukroun, & Massy, 2013;Weng et al, 2012).…”

Neurological Sequelae and Clinical Outcomes After Lung Transplantation

“…First, intact neurocognition is critical for long-term management of a complex medical regimen. 9 - 11 Second, neurocognitive functioning appears to worsen in the presence of delirium and other untoward neurological events 12 , 13 and has been shown to be predictive of long-term survival. 14 Third, it is possible that the risk of some neurological sequelae, and biobehavioral consequences after transplantation, can be mitigated by greater understanding of the occurrence and etiology of these events.…”

Up to a Third of Renal Transplant Recipients Have Deficiencies in Cognitive Functioning

“…13 Most studies have suggested improvement in cognitive functioning after successful kidney transplantation. 9,11,12,[14][15][16][17][18][19] Comparing the neuropsychological performance of patients before and after showed a significant improvement in memory performance after kidney transplantation, whereas other cognitive domains seemed to be unaffected. 15,16 However, in similar research, renal transplant recipients showed improved attention, memory, executive functioning as well as an improved psychomotor speed after successful kidney transplantation.…”