TY - JOUR
T1 - Incidence, risk factors, and sequelae of post-kidney transplant delirium
AU - Haugen, Christine E.
AU - Mountford, Alexandra
AU - Warsame, Fatima
AU - Berkowitz, Rachel
AU - Bae, Sunjae
AU - Thomas, Alvin G.
AU - Brown, Charles H.
AU - Brennan, Daniel C.
AU - Neufeld, Karin J.
AU - Carlson, Michelle C.
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara
N1 - Publisher Copyright:
Copyright © 2018 by the American Society of Nephrology.
PY - 2018/6
Y1 - 2018/6
N2 - Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium. Methods We studied 125,304 adult KT recipients (1999–2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009–2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay $2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality). Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18–49 years old: 2.0%; 50–64 years old: 4.6%; 65–75 years old: 9.2%; and $75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged $75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of $2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P,0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P,0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P,0.001). Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.
AB - Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium. Methods We studied 125,304 adult KT recipients (1999–2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009–2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay $2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality). Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18–49 years old: 2.0%; 50–64 years old: 4.6%; 65–75 years old: 9.2%; and $75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged $75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of $2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P,0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P,0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P,0.001). Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.
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U2 - 10.1681/ASN.2018010064
DO - 10.1681/ASN.2018010064
M3 - Article
C2 - 29685884
AN - SCOPUS:85048006260
SN - 1046-6673
VL - 29
SP - 1752
EP - 1759
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 6
ER -