Background: Cognitive impairment is highly prevalent in end stage renal disease. The prevalence of cognitive impairment after kidney transplantation and the factors associated with it are unknown.

Aim: To systematically determine the prevalence of cognitive impairment after kidney transplantation and elucidate the patient and clinical factors associated with cognitive impairment.

Methods: In this cross-sectional observational study, we screened randomly selected 216 kidney transplant recipients from the kidney transplant clinic in an academic center. We used the Montreal Cognitive Assessment (MoCA), a comprehensive cognitive assessment validated for use in outpatient clinics. We used ANOVA for continuous variables and Chi-square test for categorical variables. To examine the association of cognitive status with these factors, we used a multivariate logistic regression analysis including factors significant in the bivariate analysis and additional important factors. Odds ratios and 95% confidence intervals were calculated.

Results: The mean age of the participants was 55±14 years. Of the 216 patients, 71% were male, 57% were white and 57% had a college degree. A majority of the recipients (68.5%) had cognitive impairment defined by a MoCA score of <27. Bivariate analysis found that cognitive impairment was associated with age (P=0.014) and male gender (P=0.04). These associations persisted in the multivariate analysis adjusted for age, gender, level of education, time on dialysis and estimated glomerular filtration rate with OR 0.97, CI 0.94-0.99 for age and OR 3.25, CI 1.52-6.93 for male gender. There was no association with race, level of education, body mass index, blood pressure, history of comorbidities such as smoking, diabetes, coronary artery disease, peripheral vascular disease and stroke, hemoglobin, eGFR, use of prednisone, cause of ESRD, time on dialysis prior to transplant or time since transplant.

Conclusion: This is the first systematic study of cognitive impairment after kidney transplantation. We found that cognitive impairment is highly prevalent in kidney transplant recipients. This information should be factored in during patient education and monitoring of medical adherence. Further research into gender-based differences in cognitive impairment and understanding of the pathophysiology of cognitive impairment in transplant recipients is needed.

CITATION INFORMATION: Gupta A, Johnson D, Chen G, Subramaniam D, Polshak T, Thomas T, Schmitt T, Ladner D, Yu A, Burns J. Cognitive Impairment in Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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