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. 2017 May;28(5):1575-1583.
doi: 10.1681/ASN.2016080816. Epub 2016 Dec 15.

Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients

Mara A McAdams-DeMarco  1   2 , Sunjae Bae  3 , Nadia Chu  2 , Alden L Gross  2 , Charles H Brown 4th  4 , Esther Oh  5 , Paul Rosenberg  5 , Karin J Neufeld  5 , Ravi Varadhan  6 , Marilyn Albert  5 , Jeremy Walston  5 , Dorry L Segev  1   2
Affiliations

Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients

Mara A McAdams-DeMarco et al. J Am Soc Nephrol. 2017 May.

Abstract

Older patients with ESRD who receive a kidney transplant (KT) may develop post-KT dementia and Alzheimer's disease (AD) associated with their long-standing kidney disease and/or neurotoxic immunosuppressant agents. To investigate this possibility, we studied 40,918 older (aged ≥55 years) KT recipients (January 1, 1999 to December 31, 2011) linked to Medicare claims through the US Renal Data System. We estimated dementia and AD risk (cumulative incidence) and studied factors associated with these sequelae using competing risks models. We estimated the risk of death-censored graft loss and mortality after developing dementia or the AD subtype of dementia, separately, using adjusted Cox proportional hazards models. Older recipients had a 10-year dementia risk ranging from 5.1% for recipients aged 55-60 years to 17.0% for recipients aged ≥75 years; 10-year AD risk ranged from 1.0% to 6.7%, respectively. The strongest predictors for dementia and AD were older recipient age and pretransplant diabetes. The 10-year graft loss risk was 28.8% for those who did not develop dementia and 43.1% for those who did, and the corresponding mortality risks were 55.7% and 89.9%, respectively. Older recipients with dementia had a 1.52-fold (95% confidence interval, 1.39 to 1.68) increased risk of graft loss and a 2.38-fold (95% confidence interval, 2.26 to 2.49) increased risk of mortality. We observed similar results for AD. We conclude that older KT recipients have a high risk of post-KT dementia and AD, and these sequelae associate with a profound effect on patient and graft survival.

Keywords: dementia; epidemiology and outcomes; kidney transplantation.

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Figures

Figure 1.
Figure 1.
The risk of dementia by age at transplantation. The risk (cumulative incidence) was estimated for 40,918 older KT recipients using a competing risks survival analysis. Dementia represents the ICD-reported diagnoses of dementia.
Figure 2.
Figure 2.
The risk of AD by age at transplantation. The risk (cumulative incidence) was estimated for 40,918 older KT recipients using a competing risks survival analysis. AD is a subtype of dementia; therefore, the AD cases are a subset of the dementia cases. AD represents the ICD-reported diagnoses of AD.
See this image and copyright information in PMC

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