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Kidney Week

Abstract: PO1384

Changes in Cognition After Kidney Transplantation

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Gupta, Aditi, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Sharma, Palash, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Lepping, Rebecca J., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Mahnken, Jonathan D., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Brooks, William M., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Johnson, David K., University of California Davis, Davis, California, United States
  • Burns, Jeffrey M., University of Kansas Medical Center, Kansas City, Kansas, United States
Background

Longitudinal studies examining changes in cognition pre- to post-kidney transplantation (KT) are small, of short duration and do not include comprehensive neuropsychological (NP) testing or comparison with normative data.

Methods

We analysed pre- to post-KT cognition in 87 ESKD patients listed for KT and compared it to the National Alzheimer’s Coordination Center (NACC) data. We used linear mixed models for longitudinal, repeated NP test measurements, adjusted for for age, practice effect, sex, race, transplant status, and level of education, and assessed cognition pre- to post-KT for our primary (Logical Memory I, II, and Digit Symbol tests) and secondary (Mini Mental State Exam (MMSE), Digit span, Category fluency for animals & vegetables, Trail making A & B) outcomes.

Results

Data from 87 ESKD patients (age 55.8±11.7 years) and 6974 controls (age 64.9±7.9 years) were analyzed. Pre-KT, ESKD patients had lower Logical Memory I & II, Digit Symbol, MMSE, Digit Span Backward, and Category Fluency of vegetables test scores (Table 1). There was no difference in scores of Digit Span forward, Category Fluency of animals, and Trail Making A & B between pre-KT ESKD patients and controls. Post-KT, Logical Memory I and II, and Category Fluency animals & vegetables improved, while Digit Symbol, MMSE, and Digit Span backward scores remained lower than controls (Table 1).

Conclusion

Not all cognitive abilities are affected in ESKD. While some test scores improve with KT, others do not. Further studies are needed to understand the mechanisms underlying cognitive impairment in ESKD and to explore interventions to mitigate them.

Table 1: NP test comparisons in pre- and post-KT recipients and controls
Variablesp-value for any group difference (a)Pairwise comparisons
Estimated difference (p-value) (b)
Pre-KT
minus Post-KT
Pre-KT
minus controls
Post-KT
minus controls
Primary outcomes
Logical Memory I<0.001-2.14 (<0.001)-2.28 (<0.001)-0.14 (0.75)
Logical Memory II<0.001-2.82 (<0.001)-2.50 (<0.001)0.32 (0.49)
Digit Symbol<0.001-1.59 (0.07)-7.09 (<0.001)-5.49 (<0.001)
Secondary Outcomes
MMSE<0.001 -0.08 (0.61) -0.83 (<0.001) -0.74 (<0.001)
Digit Span (Forward)0.19 -0.24 (0.24) -0.37 (0.08) -0.14 (0.56)
Digit Span (Backward)<0.001 -0.34 (0.13) -1.03 (<0.001) -0.69 (0.01)
Category Fluency (Animals)<0.001 -2.17 (<0.001) -1.13 (0.05) 1.04 (0.09)
Category Fluency (Vegetables)0.05 -0.92 (0.04) -0.94 (0.03) -0.02 (0.96)
Trail Making A0.66 1.07 (0.40) 0.89 (0.52) -0.18 (0.91)
Trail Making B0.22 5.45 (0.21) 7.35 (0.11) 1.89 (0.70)
MMSE; Mini Mental State Exam, a p value for adjusted linear mixed model F-test for any group differences between pre-KT, post-KT, and controls adjusted for age, cumulative number of NP testing sessions (practice effect), race, sex and education level. b p value for adjusted linear contrast of pairwise estimated between group differences t-test.

Funding

  • Other NIH Support