Frailty and Changes in Cognitive Function after Kidney Transplantation
Frailty and Changes in Cognitive Function after Kidney Transplantation
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DOI：
10.1681/asn.2018070726
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发表时间：
2019-02-01
影响因子：
13.6
通讯作者：
McAdams-DeMarco, Mara A.
中科院分区：
文献类型：
--
作者：
Chu, Nadia M.;Gross, Alden L.;McAdams-DeMarco, Mara A.
肾脏移植后肾功能的背景恢复通常可以提高认知功能。目前尚不清楚脆弱的接受者对手术压力源的敏感性较高，实现了移植后认知改善，还是随着随着功能正常的移植而年龄的增长，他们是否经历了随后的认知下降。在这项两中心队列研究中，我们评估了成人肾脏移植受者的预处理脆弱（油炸物理脆弱表型）和认知功能（修饰的迷你精心态检查）。为了研究脆弱的潜在短期和中期对移植后认知轨迹的影响，我们测量了移植后4年的认知功能。我们使用带有随机斜率（时间）和截距（人）的调整后的混合效应模型，我们通过前植物脆弱的弱点来表征移植后的认知轨迹，这是对非线性轨迹的解释。中位数为1.5岁的665名接收者（平均年龄52.0岁）的结果为15.0％。调整后，脆弱的患者的养殖前认知评分明显降低，而非frail患者（89.0对90.8分）。移植后3个月，脆弱（每周坡度= 0.22点）和非frabe（每周坡度= 0.14点）的认知表现都提高了。移植后1至4年，非拖鞋接收者之间的改善（每周坡度= 0.005点），而脆弱的接收者的认知功能下降（坡度= -0.04点）。移植后4年时，与非弗雷尔接受者相比，脆弱的接受者的认知得分降低了5.8分。结论平均而言，脆弱的和非小型接收者都经历了移植后短期认知改善。但是，脆弱与移植后中期认知下降有关。应确定预防脆弱接受者认知能力下降的干预措施。
Background Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such post-transplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft. Methods In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short- and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories. Results Of 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =-0.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients. Conclusions On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.