Frailty and changes in cognitive function after kidney transplantation

Nadia M. Chu, Alden L. Gross, Ashton A. Shaffer, Christine E. Haugen, Silas P. Norman, Qian Li Xue, A. Richey Sharrett, Michelle C. Carlson, Karen Bandeen-Roche, Dorry L. Segev, Mara A. McAdams-DeMarco

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such posttransplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft. Methods In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short- and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories. Results Of 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =20.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients. Conclusions On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.

Original languageEnglish (US)
Pages (from-to)336-345
Number of pages10
JournalJournal of the American Society of Nephrology
Volume30
Issue number2
DOIs
StatePublished - Feb 2019

ASJC Scopus subject areas

  • General Medicine

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