Kidney Week

Abstract: TH-OR132

Cognitive Function and Waitlist Outcomes in Kidney Transplant Candidates With and Without Diabetes

Session Information

• Policy and Pretransplant Considerations
  November 07, 2019 | Location: 151, Walter E. Washington Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Chu, Nadia M., Johns Hopkins School of Medicine, Potomac, Maryland, United States

Nadia M. Chu, PhD



Dr. Chu is an epidemiologist with prior training in aging research and related methodologies, and content expertise in frailty and cognitive aging in ESRD. She is currently focusing her efforts on better understanding the intersection between physical reserve and cognitive reserve in the face of surgical stressors. Dr. Chu received her BA from the University of Pennsylvania in 2009, her MPH from the George Washington University in 2013, and her PhD from Johns Hopkins Bloomberg School of Public Health in 2018.

• Shi, Zhan, Johns Hopkins University, Baltimore, Maryland, United States

Zhan Shi,

• Haugen, Christine E., Johns Hopkins Hospital, Baltimore, Maryland, United States

Christine E. Haugen,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

Background

Kidney transplantation (KT), while contraindicated for those with diagnosed dementia, improves cognitive function in ESKD patients. However, KT candidates may have unrecognized cognitive impairment, which can lead to difficulties navigating the health system and poor health behaviors that may prolong KT evaluation, elevate mortality risk, and hinder access to KT. Therefore, we estimated the burden of cognitive impairment at KT evaluation and its association with access to KT and waitlist mortality.

Methods

In a 2-center cohort study of 3,630 ESKD participants, we estimated adjusted chance of listing (Cox), risk of waitlist mortality (competing risks), and KT rate (Poisson) by cognitive impairment (3MS<80). Given potential differences in etiology in cognitive impairment in those with and without diabetes, we tested if associations differed by diabetes (Wald test).

Results

At evaluation, 6.4% had cognitive impairment, which was independently associated with 25% lower chance of listing (aHR=0.75, 95%CI:0.61-0.91); this association did not differ by diabetes (p_interaction=0.07). However, associations between cognitive impairment and waitlist mortality (p_interaction=0.02), as well as KT rates (p_interaction=0.048) differed by diabetes. In candidates without diabetes, those with cognitive impairment had 2.47-times (95%CI:1.31-4.66) greater risk of waitlist mortality and reduced KT rate (aIRR=0.58, 95%CI:0.36-0.93); cognitive impairment was not associated with these outcomes in candidates with diabetes.

Conclusion

Clinicians should screen for cognitive impairment in KT candidates, especially among those without predisposing conditions like diabetes, and identify interventions to improve access to KT so that these vulnerable patients can experience post-KT cognitive improvements.

Funding

• NIDDK Support