Cognitive Function in Kidney Transplantation
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KIDNEY TRANSPLANTATION (M HENRY AND R PELLETIER, SECTION EDITORS)
Cognitive Function in Kidney Transplantation Andrew Jurgensen 1 & Abd Assalam Qannus 1 & Aditi Gupta 1,2
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review Cognitive impairment is common in kidney transplant recipients and affects quality of life, graft survival, morbidity, and mortality. In this review article we discuss the epidemiology, diagnosis, pathophysiology, and future directions for cognitive impairment in kidney transplantation. We describe the potential role of pre-transplant cognition, immunosuppression, and peri-transplant factors in post-transplant cognitive impairment. Recent Findings A majority of patients with kidney transplant have cognitive impairment. Cognitive impairment affects both pretransplant evaluation and post-transplant outcomes. Failure to identify patients with cognitive impairment can withhold appropriate care and timely intervention. Summary Cognitive impairment is common in kidney transplant and affects outcomes. Studies addressing modifiable risk factors and possible interventions to slow cognitive decline in patients with kidney disease are needed. Keywords Cognition . Kidney transplant . ESRD
Introduction Cognitive impairment is common in patients with kidney disease and affects kidney transplant (KT) eligibility and postKT outcomes. Prior to KT, cognitive impairment is associated with a lower likelihood of being listed for KT and, if listed, delays the time to listing [1••]. After KT cognitive impairment can affect adherence [2], quality of life, health care costs, and graft survival [3•]. The etiology of cognitive impairment in KT recipients is multifactorial. Patients with end-stage renal disease (ESRD) have a high prevalence of cognitive impairment that improves post-transplant, but residual deficits persist. These combined with the effects of immunosuppression, low physical activity [4], altered gut microbiome, posttransplant delirium [5], and traditional risk factors for dementia such as hypertension, hypercholesterolemia, metabolic
This article is part of the Topical Collection on Kidney Transplantation * Aditi Gupta [email protected] 1
Division of Nephrology, Kidney Institute and Center for Transplantation, University of Kansas Medical Center, Kansas City, KS, USA
2
Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, USA
syndrome, diabetes, and hyperuricemia likely contribute to cognitive impairment in KT. Given the significant clinical impact of cognitive impairment in KT, diagnosing and managing cognitive impairment is critical. In this review, we will discuss epidemiology, pathophysiology, and future directions for diagnosis and management of cognitive impairment in KT.
Epidemiology Up to 87% of patients on hemodialysis [6] and 75% on peritoneal dialysis [7] have cognitive impairment. Of the patients with ESRD, the ones who receive a KT tend to be healthier and have better cognition when compared with the average ESRD population [1, 8]. We and others
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