Delirium, changes in cognitive function, and risk of diagnosed dementia after kidney transplantation. Issue 12 (14th September 2022)

• Record Type: Journal Article
• Authors: Chu, Nadia M.; Bae, Sunjae; Chen, Xiaomeng; Ruck, Jessica; Gross, Alden L.; Albert, Marilyn; Neufeld, Karin J.; Segev, Dorry L.; McAdams‐DeMarco, Mara A.
• Is Part Of: American journal of transplantation. Volume 22:Issue 12(2022)
• Page Start: 2892
• Page End: 2902
• Publication Date: 2022-09-14
• Subjects: clinical research/practice -- cognitive function -- delirium -- epidemiology -- health services and outcomes research -- kidney disease -- kidney transplant -- kidney transplantation/nephrology -- mental health -- neurology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.17176
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Kidney transplant (KT) recipients with delirium, a preventable surgical complication, are likely to reap cognitive benefits from restored kidney function, but may be more vulnerable to longer‐term neurotoxic stressors post‐KT (i.e., aging, immunosuppression). In this prospective cohort study, we measured delirium (chart‐based), global cognitive function (3MS), and executive function (Trail Making Test Part B minus Part A) in 894 recipients (2009–2021) at KT, 1/3/6‐months, 1‐year, and annually post‐KT. Dementia was ascertained using linked Medicare claims. We described repeated measures of cognitive performance (mixed effects model) and quantified dementia risk (Fine & Gray competing risk) by post‐KT delirium. Of 894 recipients, 43(4.8%) had post‐KT delirium. Delirium was not associated with global cognitive function at KT (difference = −3.2 points, 95%CI: −6.7, 0.4) or trajectories post‐KT (0.03 points/month, 95%CI: −0.27, 0.33). Delirium was associated with worse executive function at KT (55.1 s, 95%CI: 25.6, 84.5), greater improvements in executive function <2 years post‐KT (−2.73 s/month, 95%CI: −4.46, −0.99), and greater decline in executive function >2 years post‐KT (1.72 s/month, 95%CI: 0.22, 3.21). Post‐KT delirium was associated with over 7‐fold greater risk of dementia post‐KT (adjusted subdistribution hazard ratio = 7.84, 95%CI: 1.22, 50.40). Transplant centers should be aware of cognitive risks associated with post‐KT delirium and implement available preventative interventions to reduce delirium risk. Abstract : Post‐kidney transplant delirium, a preventable surgical complication, is associated with improved executive function in the first two years but worse executive function thereafter, as well as a seven‐fold greater risk of diagnosed dementia.