Pretransplant Cognitive Function and Kidney Transplant Outcomes: A Prospective Cohort Study
Notice bibliographique
Résumé
Background & Hypothesis Cognitive impairment is common in patients being evaluated for a kidney transplant (KT). The association between pretransplant cognitive function and posttransplant outcomes is unclear. Study Design We performed a prospective cohort study to assess the association between pretransplant cognitive function and clinically relevant posttransplant outcomes. Setting and Population In this single center study, participants from the transplant clinic were evaluated during their pretransplant clinic visits and followed prospectively. Outcomes Our primary outcome measure was allograft function. Secondary outcomes were length of hospitalization for KT, hospital readmission within 30 and 90 days, graft loss, graft rejection within 90 days and 1 year, and mortality. Analytic Approach We measured cognitive function with the Montreal Cognitive Assessment (MoCA) test. We assessed the association of pretransplant MoCA score with posttransplant outcomes; we used linear mixed effects models to assess the association with the change in estimated glomerular filtration rate, Poisson regression for length of hospitalization, Cox proportional hazard model for graft loss and mortality, and a logistic regression model for readmission and rejection. Results We followed 501 participants for 2.7±1.5 years. The mean age of the patients was 53±14 years and the mean pretransplant MoCA score was 25±3. Lower pretransplant MoCA scores did not adversely affect the primary outcome of allograft function or the secondary outcomes. Although higher MoCA scores predicted a higher decline in graft function (β =−0.28, 95% CI: −0.55 to−0.01, P =0.04), the effect was small and not clinically significant. Older age was associated with longer hospitalization, lower likelihood of rejection, and higher mortality. Deceased donor KT (vs living donor KT) was associated with longer hospitalization but better graft function. Longer time receiving dialysis before KT was associated with longer hospitalization. A history of diabetes mellitus was associated with higher mortality. Limitations Single center study limiting generalizability. Conclusions Pretransplant MoCA scores were not associated with the primary outcome of allograft function or the secondary outcomes. Plain-Language Summary Cognitive impairment (problems with memory and thinking) is common in patients with kidney disease. Cognitive impairment is associated with problems following instructions and remembering to take medications. Medical adherence is important in kidney transplant recipients, and inability to follow instructions and missed doses of immunosuppression increases the risk of rejection of the transplanted kidney. However, kidney transplantation also improves cognition. Hence, transplant centers wonder if cognitive impairment before transplant affects clinical outcomes after kidney transplant. We tried to answer this question by assessing cognitive function before transplantation and examining whether pretransplant cognitive function affects graft function, length of hospitalization, readmission after transplantation, rejection, and death. We did not find any strong link between cognitive function before transplant and these outcomes.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».