Cognitive impairment following kidney transplantation: a narrative review of risk factors, mechanisms and management
Bibliographic record
Abstract
Background: Cognitive impairment (CI) is increasingly recognised as a clinically important, yet under-addressed, complication after kidney transplantation. Reported prevalence figures vary widely, and the underlying mechanisms and potential interventions remain incompletely integrated in the literature. Objectives: To synthesise current evidence (up to 31 March 2025) on the prevalence, longitudinal trajectory, determinants, clinical impact and emerging management strategies for CI in adult kidney-transplant recipients (KTRs). Methods: A narrative review was conducted following a systematic search of PubMed/MEDLINE, Embase, Scopus and the Cochrane Library from inception to 31 March 2025. Inclusion criteria comprised original human studies reporting quantitative or qualitative cognitive outcomes in adult KTRs; paediatric, animal, case series < 5 patients and non-English articles were excluded. Two reviewers independently screened records and extracted data. Risk of bias was assessed with the Newcastle–Ottawa Scale (observational studies) and ROB-2 (trials). Findings were synthesised thematically. Results: Fifty-seven primary studies (2006-2025) involving 9 873 KTRs met eligibility criteria. Point prevalence of CI ranged from 6.5 % to 58 % (median ≈ 38 %), with executive function and processing speed most frequently affected. Eighteen longitudinal cohorts delineated a “recover–stabilise–diverge” trajectory: rapid gains within 3 months post-transplant, plateau to 24 months, then divergence according to age and vascular burden. Consistent determinants included advanced age, diabetes, hypertension, lower eGFR, frailty and high tacrolimus exposure; mechanistic pathways converged on microvascular injury, calcineurin-inhibitor neurotoxicity and modifiable systemic factors (anaemia, inactivity). CI was associated with poorer adherence, higher rehospitalisation and reduced graft survival. Seven interventional trials demonstrated clinically relevant cognitive improvements with structured exercise, yoga/mindfulness programmes and low-dose tacrolimus, supporting the modifiability of CI. Conclusions: CI affects roughly one-third to one-half of KTRs and is driven by intersecting vascular, pharmacological and lifestyle factors. Routine MoCA-based screening, risk-stratified follow-up and multidisciplinary interventions—including exercise rehabilitation and judicious immunosuppression titration—should be integrated into standard transplant care while larger multicentre trials are awaited.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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 source (direct Gemma or distilled Codex), 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".