Journal Article Annotations
2018, 4th Quarter
Annotations by Paula Zimbrean, MD, FACLP
Type of study: Prospective cohort study
The finding: Patients with pretransplantation cognitive impairment had a higher risk for graft loss after kidney transplantation.
Strength and weaknesses: This is a prospective study of 824 kidney transplant recipients who all underwent cognitive screening upon admission for kidney transplantations and were followed for a median of 3.3 years. The study took place at two transplant centers. The authors report the risk for graft loss for patients with cognitive impairment. The analysis took into consideration multiple possible confounding variables including demographic information (age, education, employment status, insurance status), recipient medical status (years on dialysis, diabetes status, panel reactive antibody [PRA] at transplant, Hepatitis C Virus [HCV] infection, body mass index [BMI], hypertension status, history of transplantation, Charlson Comorbidity Index [CCI]), donor characteristics (age, BMI), and transplant characteristics (recipient and donor both male, zero HLA mismatches, blood type incompatibility, and transplant date). For deceased donor kidney transplant (DDKT) recipients, the analysis was adjusted for recipient factors (sex, Black race, Hispanic ethnicity, years on dialysis, diabetes status, PRA at transplant, college education, BMI, hypertension status, history of transplantation, and CCI), donor factors (kidney donor profile index [KDPI]) , and transplant factors (CIT and transplant date).
The limitations of this study consist in lack of data about the significance of cognitive impairment in patients with ESKD and the fact that social support as a risk factor for graft loss was not included in the analysis.
Relevance: Cognitive impairment is common in patients with end stage kidney disease and continues to be found after kidney transplantation. Since it is a common finding in this population, it tends to be overlooked as a risk factor for poor outcomes posttransplantation. Transplant clinicians may consider routine cognitive screening as a component of the pretransplant evaluation in order to allow implementation of supportive interventions that can reduce the risk for graft loss.
Type of study: Case control study
The finding: Young adults with RRT are less likely to be married, have children and more likely to live at home compared to general populations. They are also shorter. They were twice as likely to have psychological problems, but less likely to smoke or misuse substances. They are more likely to be unemployed despite having similar education levels compared to general population.
Strength and weaknesses: SPEAK (Surveying Patients Experiencing Young Adult Kidney Failure) Study is a single cross-sectional online self-completion survey for 16- to 30-year-olds receiving RRT in United Kingdom renal units. 976 young adults were surveyed for health related behaviors, with a response rate of 64%. The authors are reporting differences between responders and non responders, and the analysis compared findings in the dialysis group, transplantation groups and general population. The limitations of the study originate in the cross sectional design, self-reporting measures and lack of control for selection bias.
Relevance: Young adults are a particular age group that worry transplant psychiatrists due to high rate of poor adherence and adjustment difficulties. Although this study reports on young adults with RRT, not just transplantation, the findings are highly relevant to transplant psychaitrists since 80% of the group had received a kidney transplant and young adults on RRT are often evaluated for transplant candidacy.