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. 2020 Sep:7:145-153.
doi: 10.1007/s40472-020-00284-0. Epub 2020 Jul 1.

Cognitive Function in Kidney Transplantation

Andrew Jurgensen  1 , Abd Assalam Qannus  1 , Aditi Gupta  1   2
Affiliations

Cognitive Function in Kidney Transplantation

Andrew Jurgensen et al. Curr Transplant Rep. 2020 Sep.

Abstract

Purpose of the review: Cognitive impairment is common in kidney transplant recipients and affects quality of life, graft survival, morbidity, and mortality. In this review article we discuss the epidemiology, diagnosis, pathophysiology and future directions for cognitive impairment in kidney transplantation. We describe the potential role of pre-transplant cognition, immunosuppression and peri-transplant factors in post -transplant cognitive impairment.

Recent findings: A majority of patients with kidney transplant have cognitive impairment. Cognitive impairment affects both pre-transplant evaluation and post-transplant outcomes. Failure to identify patients with cognitive impairment can withhold appropriate care and timely intervention.

Summary: Cognitive impairment is common in kidney transplant and affects outcomes. Studies addressing modifiable risk factors and possible interventions to slow cognitive decline in patients with kidney disease are needed.

Keywords: Cognition; ESRD; Kidney transplant.

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Conflict of interest statement

Compliance with Ethical Standards Conflict of Interest: Dr. Gupta reports grants from Novartis, Veloxsis and NIH and consultancy from Novartis during the conduct of the study. None of these affect the work submitted by the authors.

Figures

Figure 1:
Figure 1:
Difference in perceived and measured cognition in kidney transplant recipients. Used with permission from Karger.
Figure 2:
Figure 2:
Hypothesized pathophysiology of cognitive impairment in kidney transplantation
See this image and copyright information in PMC

References

    1. Gupta A, Montgomery RN, Bedros V, et al. Subclinical Cognitive Impairment and Listing for Kidney Transplantation. Clinical journal of the American Society of Nephrology: CJASN. 2019;14(4):567–575.

      This study highlights the importance of subclinical cognitive impairment in the selection of patients for kidney transplantation. Patients with cognitive impairment have a lower liklihood of being listed for kidney transplant and take longer to get listed.

    1. Patzer RE, Serper M, Reese PP, et al. Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients. Clinical transplantation. 2016;30(10):1294–1305. - PMC - PubMed

    1. McAdams-DeMarco MA, Bae S, Chu N, et al. Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients. J Am Soc Nephrol. 2017;28(5):1575–1583.

      This study reflects the high burden of dementia in older patients with kidney transplant.

    1. van den Ham EC, Kooman JP, Schols AM, et al. Similarities in skeletal muscle strength and exercise capacity between renal transplant and hemodialysis patients. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2005;5(8):1957–1965. - PubMed
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