#543 Cognitive improvement in end stage renal disease patients post transplantation—a prospective observational study
Bibliographic record
Abstract
Abstract Background and Aims Global life expectancy at birth has increased from 66.8 years in 2000 to 73 years in 2019, as per data given by WHO in 2020. With the aging of the population, chronic kidney disease has become one of the common non communicable diseases in the world as well as one of the leading causes of mortality. Cognitive impairment begins early during chronic kidney disease and parallels kidney function decline. Cognitive dysfunction may affect the patient's daily functioning, employment options, medical adherence, medical decision making and is an independent predictor of mortality. Kidney transplantation can correct the metabolic derangements and eliminate the fluid and osmotic shifts that patients can experience on dialysis. However, cognitive impairments still persist post transplant and diagnosing and managing cognitive impairment is critical. Although there is a well established survival benefit of renal transplantation, the evidence of its effect on cognitive function is limited and not entirely consistent. Additional clinically relevant questions include whether existing comorbid conditions and associated endothelial dysfunction result in cognitive impairment that is not reversible with kidney transplant and which domains of cognition improve after transplant. This study aims to determine the proportion of patients showing cognitive improvement 3 months and 6 months post renal transplantation using Montreal Cognitive Assessment and to find the cognitive domains which show improvement post renal transplantation. This study also focusses on various parameters post transplant which may have affect the cognition of kidney transplant recipients. Method This study is a prospective observational study, conducted in a total of 100 patients, age group between 18 to 60 years who underwent renal transplantation in Medanta Hospital, India. Patients were enrolled in the study after taking informed consent. Patient demographics including age, sex, basic disease, co morbidities, dialysis vintage were recorded. Montreal cognitive assessment score was recorded during pre transplant period and was again recorded at 3 months and at 6 months posttransplant during outpatient department visits. Any episodes of infection, rejection or graft loss were recorded up to a period of 6 months post transplantation. Results with Figures 26 patients out of 100 showed improvement in Montreal Cognitive assessment score three months post renal transplantation and 56 patients out of 100 showed improvement in Montreal Cognitive assessment score 6 months post transplantation, when compared to their score at pre transplant level. The Mean Montreal cognitive assessment score at pre transplant level was 24.08 ± 3.08, at 3 months post-transplant was 24.32 ± 2.90 and at 6 months post-transplant was 25.28 ± 3.05. The difference between the mean score at 3 months post transplant when compared to mean score at pre transplant level was not found to be statistically significant p value 0.07. The difference between the mean score at 6 months post transplant when compared to the mean score at pre transplant level was found to be statistically significant p value <0.001. Among the various cognitive domains tested, delayed recall showed significant improvement after 3 months and 6 months post transplant with p values of 0.016 and < 0.001 respectively. Conclusion Significant cognitive improvement was seen 6 months post renal transplant. Delayed recall showed significant improvement after 3 and 6 months post renal transplant. This study concluded that patients who showed improvement in cognition 6 months post transplant did not show any significant correlation between the parameters studied such as serum sodium, calcium, haemoglobin, creatinine, age, rates of rejection and infection or use of any specific induction agent and improvement in Montreal cognitive assessment score. The screening for cognitive functions after kidney transplantation is not yet a routine practice and must be included in the routine follow up of the kidney transplant recipients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".