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Meta-analysis of cognitive functioning in patients following kidney transplantation.

ABSTRACT: Background:There is mixed evidence regarding the nature of cognitive function in patients who have undergone renal transplantation. The aim of this meta-analysis was to examine which cognitive domains are impacted following kidney transplantation and how performance compares with non-transplanted patients or healthy controls/normative data. Method:A systematic search was conducted using keywords within three databases (Embase, MEDLINE and PsychINFO), yielding 458 unique studies, 10 of which met the inclusion criteria. Neuropsychological tests were grouped into nine cognitive domains and three separate analyses were undertaken within each domain: (i) within subjects pre- versus post-transplant, (ii) transplanted versus non-transplanted patients and (iii) transplanted versus healthy matched controls and standardized normative data. Results:Transplanted patients showed moderate to large improvements in the domains of general cognitive status (g?=?0.526), information and motor speed (g?=?0.558), spatial reasoning (g?=?0.376), verbal memory (g?=?0.759) and visual memory (g?=?0.690) when compared with their pre-operative scores. Test scores in the same five domains were significantly better in post-transplanted patients when compared with dialysis-dependant or conservatively managed chronic kidney disease patients. However, post-transplanted patients' performance was significantly low compared with that of healthy controls (and standardized normative data) in the domains of executive functioning (g?=?-0.283), verbal fluency (g?=?-0.657) and language (g?=?-0.573). Conclusions:Two key issues arise from this review. First, domain-specific cognitive improvement occurs in patients after successful transplantation. Nevertheless, transplanted patients still performed significantly below healthy controls in some domains. Second, there are important shortcomings in existing studies; the length of follow-up is typically short and only limited neuropsychological test batteries are employed. These factors are important in order to support the recovery of cognitive function among patients following renal transplant.

SUBMITTER: Joshee P

PROVIDER: S-EPMC6031036 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Meta-analysis of cognitive functioning in patients following kidney transplantation.

Joshee Paras P Wood Amanda G AG Wood Eleri R ER Grunfeld Elizabeth A EA

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 20180701 7

<h4>Background</h4>There is mixed evidence regarding the nature of cognitive function in patients who have undergone renal transplantation. The aim of this meta-analysis was to examine which cognitive domains are impacted following kidney transplantation and how performance compares with non-transplanted patients or healthy controls/normative data.<h4>Method</h4>A systematic search was conducted using keywords within three databases (Embase, MEDLINE and PsychINFO), yielding 458 unique studies, 1 ...[more]

PMID: 28992229

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Project description:BackgroundNeurobehavioral functioning is widely recognized as being an important consideration in lung transplant candidates, but little is known about whether these factors are related to clinical outcomes. The present study examined the relationship of neurobehavioral functioning, including measures of executive function and memory, depression, and anxiety, to long-term survival among lung transplant recipients.MethodsThe sample was drawn from 201 patients who underwent transplantation at Duke University and Washington University who participated in a dual-site clinical trial investigating medical and psychosocial outcomes in transplant candidates with end-stage lung disease. All patients completed the Beck Depression Inventory-II (BDI-II) and Spielberger State-Trait Anxiety Inventory at baseline and again after 12 weeks, while a subset of 86 patients from Duke University also completed neurocognitive testing. Patients were followed for survival up to 12 years after completing baseline assessments.ResultsOne hundred eleven patients died over a mean follow-up of 10.8 years (SD=0.8). Baseline depression, anxiety, and neurocognitive function were examined as predictors of posttransplant survival, controlling for age, 6-min walk distance, FEV, and native disease; education and cardiovascular risk factors were also included in the model for neurocognition. Lower executive function (hazard ratio [HR]=1.09, P=.012) and memory performance (HR=1.11, P=.030) were independently associated with greater mortality following lung transplant. Although pretransplant depression and anxiety were not predictive of mortality, patients who scored>13 on the BDI-II at baseline and after 3 months pretransplant had greater mortality (HR=1.85 [95% CI, 1.04, 3.28], P=.036).ConclusionsNeurobehavioral functioning, including persistently elevated depressive symptoms and lower neurocognitive performance, was associated with reduced survival after lung transplantation.Trial registryClinicalTrials.gov; No.: NCT00113139; URL: www.clinicaltrials.gov.

Project description:BackgroundPatients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and kidney transplantation and to identify predictors of employment during dialysis and posttransplant.MethodsThis systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross-sectional or cohort studies published in English between January 1966 and August 2020 in the PubMed, Embase, and Cochrane Library databases. Data on employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis for predictors for employment, with odds ratios and confidence intervals, and tests for heterogeneity, using chi-square and I2 statistics, were calculated. PROSPERO registration number: CRD42020188853.ResultsThirty-three studies included 162,059 participants receiving dialysis, and 31 studies included 137,742 participants who received kidney transplantation. Dialysis patients were on average 52.6 years old (range: 16-79; 60.3% male), and kidney transplant patients were 46.7 years old (range: 18-78; 59.8% male). The employment rate (weighted mean) for dialysis patients was 26.3% (range: 10.5-59.7%); the employment rate was 36.9% pretransplant (range: 25-86%) and 38.2% posttransplant (range: 14.2-85%). Predictors for employment during dialysis and posttransplant were male, gender, age, being without diabetes, peritoneal dialysis, and higher educational level, and predictors of posttransplant: pretransplant employment included transplantation with a living donor kidney, and being without depression.ConclusionsPatients with kidney failure had a low employment rate during dialysis and pre- and posttransplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure that they remain working.

Project description:BackgroundFabry disease (FD) is a rare X-linked lysosomal storage disorder with progressive systemic deposition of globotriaosylceramide, leading to life-threatening cardiac, central nervous system, and kidney disease. Current therapy involves symptomatic medical management, enzyme replacement therapy (ERT), dialysis, kidney transplantation, and, more recently, gene therapy. The aim of this systematic review was to assess outcomes of kidney transplantation among patients with FD.MethodsA comprehensive literature review was conducted utilizing MEDLINE, EMBASE, and Cochrane Database, from inception through to 28 February 2020, to identify studies that evaluate outcomes of kidney transplantation including patient and allograft survival among kidney transplant patients with FD. Effect estimates from each study were extracted and combined using the random-effects generic inverse variance method of DerSimonian and Laird.ResultsIn total, 11 studies, including 424 kidney transplant recipients with FD, were enrolled. The post-transplant median follow-up time ranged from 3 to 11.5 years. Overall, the pooled estimated rates of all-cause graft failure, graft failure before death, and allograft rejection were 32.5% (95%CI: 23.9%-42.5%), 14.5% (95%CI: 8.4%-23.7%), and 20.2% (95%CI: 15.4%-25.9%), respectively. In the sensitivity analysis, limited only to the recent studies (year 2001 or newer when ERT became available), the pooled estimated rates of all-cause graft failure, graft failure before death, and allograft rejection were 28.1% (95%CI: 20.5%-37.3%), 11.7% (95%CI: 8.4%-16.0%), and 20.2% (95%CI: 15.5%-26.0%), respectively. The pooled estimated rate of biopsy proven FD recurrence was 11.1% (95%CI: 3.6%-29.4%), respectively. There are no significant differences in the risks of all-cause graft failure (p = 0.10) or mortality (0.48) among recipients with vs. without FD.ConclusionsDespite possible FD recurrence after transplantation of 11.1%, allograft and patient survival are comparable among kidney transplant recipients with vs. without FD.

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Meta-analysis of cognitive functioning in patients following kidney transplantation.

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Meta-analysis of cognitive functioning in patients following kidney transplantation.

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