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Kidney Week

Abstract: TH-PO943

Physical Frailty and Cognitive Change Among Kidney Transplant Recipients

Session Information

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 weeks4 - 12 weeks12 - 24 weeks24 - 52 weeks
Overall0.48
(0.29, 0.68)*
0.26
(0.050, 0.46)*
-0.021
(-0.16, 0.12)
0.035
(-0.013, 0.082)
Non-Frail0.53
(0.33, 0.73)*
0.25
(0.031, 0.47)*
-0.011
(-0.16, 0.14)
0.021
(-0.031, 0.073)
Frail0.20
(-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