Abstract: PO1703
Post-Operative Delirium and Cognitive Decline in Kidney Transplantation
Session Information
- Advances in Geriatric Nephrology
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1100 Geriatric Nephrology
Authors
- Chu, Nadia M., Johns Hopkins University, Baltimore, Maryland, United States
- Chen, Xiaomeng, Johns Hopkins University, 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
Post-operative delirium may be a marker for greater cognitive vulnerability to stressors. As such, those with post-operative delirium may experience steeper decline in cognitive performance following stressors of surgery post-KT.
Methods
We used a single center cohort of 912 adult KT recipients with delirium assessments abstracted from medical records and global (3MS) and domain-specific (executive function: time to complete TMT-B minus TMT-A) cognitive performance measured at KT, 1-month, 3-months, 6-months, 1-year, and annually thereafter post-KT. We used mixed effects models to describe repeated measures of cognitive performance and compare trajectories by post-operative delirium.
Results
Among 912 KT recipients, 44 (4.8%) had post-operative delirium. Delirium was associated with higher levels of cognitive impairment at KT (18.2% vs 8.0%), and was associated with lower 3MS component scores including memory, identification/association, and orientation. After adjustment, those with delirium had 3MS scores that were on average 3.6 points lower than those without delirium (95%CI: -6.9, 0.3) at time of KT; delirium was not associated with differing global cognitive trajectories post-KT (difference=0.04 points/month, 95%CI:-0.1, 0.2) (Figure1A). However, delirium was associated with lower executive function at KT (difference=44.0s, 95%CI: 17.4, 70.6) and steeper decline in executive function post-KT (difference=-1.1s/month, 95%CI:-2.1,-0.05) (Figure1B).
Conclusion
KT recipients with delirium experience greater decline in executive function, indicating greater cognitive vulnerability with potential vascular etiologies. Nephrologists and transplant centers should be aware of cognitive risks associated with post-KT delirium and implement available preventative interventions to reduce risk of delirium.
Funding
- NIDDK Support