BACKGROUND AND OBJECTIVES: Cognitive impairment is common in patients with kidney disease and can affect physicians' perception and/or patients' ability to complete the pretransplant evaluation. We examined whether cognitive impairment influences the likelihood for transplant listing and whether patients with cognitive impairment take longer to be listed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a single-center longitudinal cohort study. Patients presenting for their index kidney transplant evaluation were screened for cognitive impairment using the Montreal Cognitive Assessment. A score <26 indicated cognitive impairment. The transplant selection committee was blinded to the scores. Kaplan-Meier analysis assessed time to active listing by level of cognition. A Cox proportional hazards model that included age, sex, race/ethnicity, smoking, coronary artery disease, and diabetes was constructed to evaluate the association between Montreal Cognitive Assessment score and listing for transplant. RESULTS: In total, 349 patients who underwent Montreal Cognitive Assessment testing at their initial visit were included in the analysis. Patients with cognitive impairment were more likely to be older, black, and smokers. The time to listing in patients with cognitive impairment was longer than the time to listing in those with no cognitive impairment (median time, 10.6 versus 6.3 months; log rank test P=0.01). Cognitive impairment was independently associated with a lower likelihood of being listed for transplant (hazard ratio, 0.93 per unit lower Montreal Cognitive Assessment score; 95% confidence interval, 0.88 to 0.99; P=0.02). A lower proportion of patients with cognitive impairment were listed compared with patients without cognitive impairment at 1 month (2% versus 11%), 6 months (17% versus 37%), and 1 year (23% versus 41%), (P<0.001 for all). CONCLUSIONS: Cognitive impairment is associated with a lower likelihood of being listed for kidney transplant, and is associated with longer time to transplant listing.
BACKGROUND AND OBJECTIVES: Cognitive impairment is common in patients with kidney disease and can affect physicians' perception and/or patients' ability to complete the pretransplant evaluation. We examined whether cognitive impairment influences the likelihood for transplant listing and whether patients with cognitive impairment take longer to be listed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a single-center longitudinal cohort study. Patients presenting for their index kidney transplant evaluation were screened for cognitive impairment using the Montreal Cognitive Assessment. A score <26 indicated cognitive impairment. The transplant selection committee was blinded to the scores. Kaplan-Meier analysis assessed time to active listing by level of cognition. A Cox proportional hazards model that included age, sex, race/ethnicity, smoking, coronary artery disease, and diabetes was constructed to evaluate the association between Montreal Cognitive Assessment score and listing for transplant. RESULTS: In total, 349 patients who underwent Montreal Cognitive Assessment testing at their initial visit were included in the analysis. Patients with cognitive impairment were more likely to be older, black, and smokers. The time to listing in patients with cognitive impairment was longer than the time to listing in those with no cognitive impairment (median time, 10.6 versus 6.3 months; log rank test P=0.01). Cognitive impairment was independently associated with a lower likelihood of being listed for transplant (hazard ratio, 0.93 per unit lower Montreal Cognitive Assessment score; 95% confidence interval, 0.88 to 0.99; P=0.02). A lower proportion of patients with cognitive impairment were listed compared with patients without cognitive impairment at 1 month (2% versus 11%), 6 months (17% versus 37%), and 1 year (23% versus 41%), (P<0.001 for all). CONCLUSIONS: Cognitive impairment is associated with a lower likelihood of being listed for kidney transplant, and is associated with longer time to transplant listing.
Authors: Ziad S Nasreddine; Natalie A Phillips; Valérie Bédirian; Simon Charbonneau; Victor Whitehead; Isabelle Collin; Jeffrey L Cummings; Howard Chertkow Journal: J Am Geriatr Soc Date: 2005-04 Impact factor: 5.562
Authors: Rebecca F Gottesman; Marilyn S Albert; Alvaro Alonso; Laura H Coker; Josef Coresh; Sonia M Davis; Jennifer A Deal; Guy M McKhann; Thomas H Mosley; A Richey Sharrett; Andrea L C Schneider; B Gwen Windham; Lisa M Wruck; David S Knopman Journal: JAMA Neurol Date: 2017-10-01 Impact factor: 18.302
Authors: David A Drew; Daniel E Weiner; Hocine Tighiouart; Sarah Duncan; Aditi Gupta; Tammy Scott; Mark J Sarnak Journal: Am J Kidney Dis Date: 2017-01-26 Impact factor: 8.860
Authors: Rajiv Saran; Yi Li; Bruce Robinson; John Ayanian; Rajesh Balkrishnan; Jennifer Bragg-Gresham; Joline T L Chen; Elizabeth Cope; Debbie Gipson; Kevin He; William Herman; Michael Heung; Richard A Hirth; Steven S Jacobsen; Kamyar Kalantar-Zadeh; Csaba P Kovesdy; Alan B Leichtman; Yee Lu; Miklos Z Molnar; Hal Morgenstern; Brahmajee Nallamothu; Ann M O'Hare; Ronald Pisoni; Brett Plattner; Friedrich K Port; Panduranga Rao; Connie M Rhee; Douglas E Schaubel; David T Selewski; Vahakn Shahinian; John J Sim; Peter Song; Elani Streja; Manjula Kurella Tamura; Francesca Tentori; Paul W Eggers; Lawrence Y C Agodoa; Kevin C Abbott Journal: Am J Kidney Dis Date: 2015-07 Impact factor: 8.860
Authors: E Benedetti; M Asolati; T Dunn; D A Walczak; P Papp; A M Bartholomew; Y Smith; A W Washington; R Pollak Journal: Am J Kidney Dis Date: 1998-03 Impact factor: 8.860
Authors: Robert S Gaston; Gabriel M Danovitch; Patricia L Adams; James J Wynn; Robert M Merion; Mark H Deierhoi; Robert A Metzger; J Michael Cecka; William E Harmon; Alan B Leichtman; Aaron Spital; Emily Blumberg; Charles A Herzog; Robert A Wolfe; Dolly B Tyan; John Roberts; Richard Rohrer; Friedrich K Port; Francis L Delmonico Journal: Am J Transplant Date: 2003-07 Impact factor: 8.086
Authors: Yechiam Ostchega; Charles F Dillon; Jeffery P Hughes; Margaret Carroll; Sarah Yoon Journal: J Am Geriatr Soc Date: 2007-07 Impact factor: 5.562
Authors: Frances E Tiffin-Richards; Ana S Costa; Bernhard Holschbach; Rolf D Frank; Athina Vassiliadou; Thilo Krüger; Karl Kuckuck; Theresa Gross; Frank Eitner; Jürgen Floege; Jörg B Schulz; Kathrin Reetz Journal: PLoS One Date: 2014-10-27 Impact factor: 3.240
Authors: Nadia M Chu; Zhan Shi; Christine E Haugen; Silas P Norman; Alden L Gross; Daniel C Brennan; Michelle C Carlson; Dorry L Segev; Mara A McAdams-DeMarco Journal: Am J Kidney Dis Date: 2020-02-03 Impact factor: 8.860
Authors: Prakriti Shrestha; Sarah E Van Pilsum Rasmussen; Elizabeth A King; Elisa J Gordon; Ruth R Faden; Dorry L Segev; Casey Jo Humbyrd; Mara McAdams-DeMarco Journal: BMC Geriatr Date: 2022-07-08 Impact factor: 4.070
Authors: Rebecca J Lepping; Robert N Montgomery; Palash Sharma; Jonathan D Mahnken; Eric D Vidoni; In-Young Choi; Mark J Sarnak; William M Brooks; Jeffrey M Burns; Aditi Gupta Journal: J Am Soc Nephrol Date: 2020-10-16 Impact factor: 10.121
Authors: Nadia M Chu; Xiaomeng Chen; Alden L Gross; Michelle C Carlson; Jacqueline M Garonzik-Wang; Silas P Norman; Aarti Mathur; Maheen Z Abidi; Daniel C Brennan; Dorry L Segev; Mara A McAdams-DeMarco Journal: Clin Transplant Date: 2021-08-03 Impact factor: 3.456