Abstract: TH-PO943
Physical Frailty and Cognitive Change Among Kidney Transplant Recipients
Session Information
- Transplantation: AKI, Cardiovascular, and Metabolic Complications
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Chu, Nadia M., Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Gross, Alden Lawrence, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Xue, Qianli, Johns Hopkins University, Baltimore, Maryland, United States
- Bandeen-roche, Karen J., Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Sharrett, Richey, Johns Hopkins University, Baltimore, Maryland, United States
- Carlson, Michelle C, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
- McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
Background
With restoration of kidney function, kidney transplant (KT) recipients may experience preserved or improved cognitive function. However, KT recipients have a higher burden of frailty at the time of KT, and frail recipients may not experience this potential benefit. The goal of this prospective study was to assess post-KT cognitive trajectories by frailty status (12/2008 – 12/2016).
Methods
Participants completed a physical frailty exam (five Fried criteria) and global cognitive testing (3MS) at time of KT-admission, as well as at least one cognitive test during post-KT. We used a mixed effects model adjusted for follow-up time, age, sex, race, donor type, and 3MS score at time of KT with a random slope (time) and intercept (person) to describe multiple 3MS scores post-KT by frailty status.
Results
Of 665 KT recipients (mean age 52 years) followed for a mean of 2.2 years (3.7 visits), 15.2% were frail, and the mean 3MS score was 92.5 at time of KT. In the first month post-KT, non-frail recipients experienced a significantly greater rate of cognitive improvement (0.53 points-per-week, 95% CI: 0.33, 0.73), however there was no evidence of such an improvement among frail recipients (0.20 points-per-week, 95% CI: -0.35, 0.75). Rates of cognitive change among non-frail KT recipients continued to increase 1-3 months post-KT, and plateaued thereafter through 1 year post-KT. Frail individuals did not significantly improve anytime during the year post-KT.
Conclusion
In conclusion, frailty is associated with mitigated improvement in global cognition post-KT. Frail recipients may benefit from interventions to improve cognitive function after KT.
Rates of Change in Global Cognition Overall and By Physical Frailty Status within Specified Time Intervals post-KT (95% Confidence Intervals) in 3MS points per week
| <= 4 weeks | 4 - 12 weeks | 12 - 24 weeks | 24 - 52 weeks | |
| Overall | 0.48 (0.29, 0.68)* | 0.26 (0.050, 0.46)* | -0.021 (-0.16, 0.12) | 0.035 (-0.013, 0.082) |
| Non-Frail | 0.53 (0.33, 0.73)* | 0.25 (0.031, 0.47)* | -0.011 (-0.16, 0.14) | 0.021 (-0.031, 0.073) |
| Frail | 0.20 (-0.35, 0.75) | 0.30 (-0.31, 0.91) | -0.085 (-0.49, 0.31) | 0.11 (-0.0031, 0.22) |
* Statistically significant at a cut-off p=0.05. All models adjusted for baseline age (centered at 55), race, education, self-reported quality of life, donor type (live or dead), and the Charlson Comorbidity Index adapted for ESRD patients.
Funding
- NIDDK Support