Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Background: Kidney transplantation (KT) is a growing treatment option for older ESRD patients. Older recipients may develop post-KT dementia and Alzheimer's disease (AD) associated with their long-standing kidney disease and/or neurotoxic immunosuppressant agents.
Methods: We studied 40,918 older (aged≥55) KT recipients (1/1/99-12/31/11) linked to Medicare claims through USRDS. We estimated dementia and AD risk (cumulative incidence) and studied factors associated with these sequelae using competing risks models. We estimated the risk of death-censored graft loss and mortality after developing dementia or AD subtype of dementia, separately, using adjusted Cox proportional hazards models.
Results: Older recipients had a 10-year dementia risk ranging from 5.1% for recipients aged 55-60 to 17.0% for recipients aged≥75; 10-year AD risk ranged from 1.0% to 6.7%, respectively. The strongest predictors for dementia and AD were older recipient age (5-year difference: dementia HR=1.50, 95%CI:1.46-1.56; AD HR=1.69, 95%CI:1.59-1.80) and pre-transplant diabetes (dementia HR=1.64, 95%CI:1.51-1.78; AD HR=1.32, 95%CI:1.11-1.56). The 10-year graft loss risk was 28.8% for those who did not develop dementia and 43.1% for those who did, and the corresponding mortality risks were 55.7% and 89.9%. Older recipients with dementia were at 1.52-fold (95%CI:1.39-1.68) increased risk of graft loss and 2.38-fold (95%CI:2.26-2.49) increased risk of mortality. Similar results were observed for AD.
Conclusions: Older KT recipients have a high risk of post-KT dementia and AD, and these sequelae are associated with a profound impact on patient and graft survival. There is the need for greater awareness of the risk for dementia and AD in older patients undergoing KT.
CITATION INFORMATION: McAdams DeMarco M, Bae S, Chu N, Gross A, Brown IV C, Oh E, Rosenberg P, Neufeld K, Varadhan R, Albert M, Walston J, Segev D. Dementia and Alzheimer's Disease Among Older Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:DeMarco MMcAdams, Bae S, Chu N, Gross A, IV CBrown, Oh E, Rosenberg P, Neufeld K, Varadhan R, Albert M, Walston J, Segev D. Dementia and Alzheimer's Disease Among Older Kidney Transplant Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/dementia-and-alzheimers-disease-among-older-kidney-transplant-recipients/. Accessed September 23, 2020.
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